Eastern Cardiothoracic Surgical Society

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Robotic-assisted right upper bilobectomy with pericardial resection
Andrei Gritsiuta1, Abbas Abbas2, Charles Bakhos2, Roman Petrov1.
1University of Pennsylvania, Philadelphia, PA, USA, 2Temple University, Philadelphia, PA, USA.

OBJECTIVE: 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. We present a case of robotic assisted bilobectomy with pericardial resection and reconstruction in patient with locally advanced lung cancer.
METHODS: A 62-years-old AA male presented with complaints of chronic cough and hemoptysis. Chest X-ray revealed lung mass. Preoperative workup revealed an FDG avid 5.3 cm within the right middle lobe. No distant metastases was revealed. A patient was deemed a surgical candidate and was brought for elective robotic resection.
RESULTS: Intraoperatively large right middle was identified with extension across the minor fissure. Decision was to proceed with bilobectomy. Dissection was complicated by atypical vascular anatomy and concerns for pericardial invasion. Robotic bilobectomy with pericardial resection and reconstruction was completed. Postoperatively procedure was complicated by bleeding and hemothorax, requiring return to OR. Upon VATS exploration bleeding was localized to apical parietal pleura believed to be result of CT trauma unrelated to the surgical dissection. Patient underwent uneventful recovery. Final pathology revealed pT3N1 adenocarcinoma with 5.9 cm tumor and one intrapulmonary nodal metastasis.
CONCLUSIONS: In the video technique of robotic bilobectomy with pericardial resection and reconstruction is demonstrated.


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