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Robotic Right Middle Lobe Sleeve Lobectomy: Surgical Approach And Technical Pearls
James T. Nawalaniec, MD, Hugh G. Auchincloss, MD, Christina L. Costantino, MD.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: To demonstrate the robotic surgical approach and technical considerations when performing a right middle lobe sleeve lobectomy.
METHODS: We identified a challenging airway case involving a right middle lobe carcinoid tumor. The operation was performed using a robotic surgical approach, and the case was recorded and edited to present the key technical aspects of the operation.
RESULTS: The video begins with a brief clinical summary describing a young, healthy patient presenting with an obstructing carcinoid tumor originating from the right middle lobar bronchus. Preoperative bronchoscopy is shown demonstrating the endobronchial tumor growth into the bronchus intermedius and abutting the minor carina of the right lower lobe. The cuff of grossly normal lower lobe bronchus appears of adequate length for a sleeve resection and bronchial anastomosis to spare the right lower lobe. The technical aspects of both the resection and the anastomosis are then demonstrated, with particular attention to the technique of the robotic handsewn bronchial anastomosis. Final pathology was consistent with a 3.4cm typical carcinoid tumor of the right middle lobe, with negative bronchial margins. The video concludes with six-month surveillance imaging and bronchoscopy, demonstrating a widely patent anastomosis and no recurrent disease.
CONCLUSIONS: Historically, pulmonary sleeve resections, especially a right middle lobe sleeve, were performed via open thoracotomy given the careful and extensive dissection required around the hilar structures and the technical difficulty of a handsewn airway anastomosis. The robotic approach can match this technical precision while offering patients a minimally invasive alternative to thoracotomy.
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