Use of Cardiopulmonary Bypass for Complex Robotic Left Upper Lobectomy After Prior Mantle Radiation

C. Michael. Poulos¹, R. Cassidy¹, L. Schumacher^2
1Tufts Medical Center, Boston, Massachusetts ²Tufts Medical Center, Dvoer, Massachusetts

Please explain the educational or technical point that this video addresses.: Patients who received mantle radiation for prior lymphoma are aging and at risk of developing secondary malignancies. Due to the high dose and wide field of radiation, patients diagnosed with secondary lung cancers are presenting with locally advanced disease within hostile surgical fields. There is very little literature documenting the potential operative difficulties of this unique population, specifically the intense inflammatory/adhesive reaction present. In this video, we complete a totally robotic left upper lobectomy with institution of cardiopulmonary bypass on a young patient with high surgical risk in setting of ischemic heart disease, pulmonary hypertension, and locally advanced lung cancer. Through a carefully planned, team-based approach in conjunction with cardiac surgery/cardiac anesthesia, the patient had an uneventful operative course despite these risk factors. The video details a number of advanced robotic techniques to safely complete an otherwise extremely difficult, high-risk left upper lobectomy.

Please provide a 250 word summary of the surgical video being submitted.: This case is a completely robotic left upper lobectomy on cardiopulmonary bypass via femoral cannulation in a patient with prior mantle radiation and pulmonary hypertension. The case highlights a number of advanced robotic techniques including the initiation of cardiopulmonary bypass, intrapericardial control of the left main pulmonary artery, total vascular control of the left upper lobe, transection of the bronchial tree with mobilization of pulmonary artery, and fissureless approach in setting of significant post-radiation adhesions.