Management of Difficult Anterior Pulmonary Artery Branch During Robotic-Assisted Left Upper Lobectomy

In this video, a technique of complex robotic-assisted left upper lobectomy with difficult anterior pulmonary artery branch is demonstrated to advance the knowledge among practicing surgeons on technical nuances of complex pulmonary surgery. A 61-year-old man with newly diagnosed left upper lobe squamous cell carcinoma T1cN0M0 clinical stage IA was presented for surgical treatment. Intraoperatively, only division of the left upper lobe bronchus allowed for safely identifying challenging anatomical features of the anterior branch of the pulmonary artery. The left upper bronchial stump was closed using running 3-0 absorbable V-lock suture. The patient’s postoperative course was complicated by COVID-19 infection, respiratory failure, and prolonged air leak. He was intubated with subsequent tracheostomy and prolonged hospital stay. He was discharged to the nursing facility on postoperative day 44. However, this complication was not related to the surgical technique.