Robotic bronchial sleeve resections: technical details and early results

Aim: We report our four-arm robotic bronchial sleeve anatomical lung resection technique and its early results.Methods: We retrospectively collected all the four-arm robotic sleeve anatomical lung resections we performed in our institution from February 2014 to August 2019. We reported the results as a series of cases.Results: During that period, 582 robotic procedures were performed by a single surgeon, of which 486 were major anatomical lung resections. From this group, 10 patients (2%) underwent bronchial sleeve resections. All patients were treated on the right lung. Neither conversion nor major events occurred during surgery. The first bronchial sleeve was performed for Patient 219. The mean length of procedure was 164 (± 43) min. One patient died during hospitalization due to a non-related complication (gastric massive bleeding). Three patients had no complications. Six had minor complications (Clavien Dindo Grade 2) resulting in prolonged length of stay. The mean length of stay was 10 (± 5.7) days. No bronchial fistula occurred. All resection margins were R0.Conclusion: Four-arm robotic bronchial sleeve is a feasible and safe procedure. Telemanipulation surgery offers excellent technical conditions to ensure a hand-sewed anastomosis and R0 resection. The technical principle and dissection are the same as those of open surgery. Patient selection and mastering of the telemanipulation device are mandatory to perform these complex and rare procedures