Robotic Sleeve Resection of the Bronchus Intermedius
The authors have previously described a parenchymal-sparing sleeve resection of the bronchus intermedius for isolated strictures (1). Recently, they described a robotic parenchymal-sparing bronchus intermedius sleeve resection in a patient with a benign endobronchial lesion (2). In the video here, Caso and Marshall demonstrate the technical aspects of a complete portal robotic sleeve resection of the bronchus intermedius.
The patient was a 69-year-old woman who was found to have an endobronchial lesion that was not successfully resected endoscopically. A cautery artifact obscured the diagnosis with pathology suspicious for carcinoma, however the overall clinical picture was more suggestive of a benign lesion. The patient underwent a sleeve resection of the bronchus intermedius with final pathology showing benign adenoma. She tolerated the procedure well. There were no anastomotic or other complications.
Robotic-assisted thoracic surgery is increasingly being utilized for the performance of complex thoracic procedures. However, due to the concern with performing an oncologic resection and the steep learning curve, a minimally invasive sleeve resection and bronchial anastomosis has yet to be adopted by most thoracic surgeons. This video demonstrates the feasibility and utility of robotic-assisted thoracic surgery in the management of benign pathology of the bronchus intermedius.
- Paulson EC, Singhal S, Kucharczuk JC, Sterman DH, Kaiser LR, Marshall MB. Bronchial sleeve resection for posttransplant stricture. Ann Thorac Surg. 2003;76(6):2075-2076.
- Caso R, Watson TJ, Marshall MB. Complete portal robotic sleeve resection of the bronchus intermedius. J Vis Surg. 2018;4:203.