Robotic right upper sleeve lobectomy with bronchoplasty for primary adenocarcinoma

Sleeve lobectomy with bronchoplasty is a complex yet lung-sparing procedure traditionally performed via open thoracotomy. Robotic-assisted thoracoscopic surgery, with enhanced visualization and instrument dexterity, may facilitate this technically demanding procedure in a minimally invasive setting. We report the case of an 85-year-old man with adenocarcinoma in the right upper lobe, accompanied by an isolated intrapulmonary metastasis and an enlarged lymph node #4R and #11s, with #11s invading the orifice of the right upper lobe bronchus. The clinical stage was cT3N2aM0 (stage IIIB). Because of bronchial involvement by metastatic lymph node #11s, robotic right upper sleeve lobectomy with bronchoplasty was performed. A five-port approach was used. The right upper lobe pulmonary vessels were individually dissected and divided using robotic staplers. After sleeve resection of the bronchus, bronchial reconstruction was completed with a continuous barbed suture. The anastomosis was reinforced with a free pericardial fat pad and fibrin sealant. Console time was 226 minutes, with minimal blood loss. The chest tube was removed on postoperative Day 1, and the patient was discharged on postoperative Day 5 without complications. Pathology confirmed pT3N2bM0 adenocarcinoma with negative margins. Robotic right upper sleeve lobectomy with bronchoplasty may be a feasible minimally invasive option in selected patients requiring complex airway reconstruction.