Robotic-Assisted Right Upper Bilobectomy With Pericardial Resection

Rapid adoption of minimally invasive surgery into clinical practice has conveyed improvements in outcomes across many surgical specialties. Robotic surgery offers additional advantages due to imbedded safety technologies, improved dexterity, and digital enhancement. However, wide adoption of the robotic technology is still lacking due to complexity of the field.

A 62-year-old man presented with complaints of chronic cough and hemoptysis. Chest x-ray revealed a right lung mass. PET CT showed an FDG avid 5.3 cm tumor within the right middle lobe invading the upper lobe. On biopsy, this was found to be adenocarcinoma. Preoperative staging workup revealed no distant metastases and after comprehensive preoperative evaluation, the patient was deemed a surgical candidate and brought for elective robotic resection. Intraoperatively, the large right middle lobe neoplasm was identified with extension across the minor fissure. The decision was made to proceed with bilobectomy. The dissection was complicated by atypical vascular anatomy and concerns for pericardial invasion. Robotic bilobectomy with pericardial resection and reconstruction was completed. The use of robotic technology has facilitated identification of the structures, dissection, and conduct of this complex operation. The procedure was complicated by postoperative bleeding and hemothorax, requiring return to the OR. Upon VATS exploration, the bleeding was localized to the apical parietal pleura, believed to be the result of CT trauma unrelated to the surgical dissection. The patient underwent an uneventful recovery and was discharged home on postoperative day six. Final pathology revealed pT3N1 adenocarcinoma with a 5.9 cm tumor and one intrapulmonary nodal metastasis.