Robotic Secondary Carina Resection and Reconstruction

B. Wei¹, W. Kim^2
1University of Alabama at Birmingham, Birmingham, Alabama ²University of Alabama at Birmingham, Jeonju-si, Cholla-bukto

Please explain the educational or technical point that this video addresses.: Secondary carina resection with complete preservation of all lung parenchyma is a rare operation.

Please provide a 250 word summary of the surgical video being submitted.: The patient was a 37-year-old man with a 2 cm endobronchial mass located in the distal left mainstem bronchus. His DLCO was 72% and FEV1 was 48% of predicted. Bronchoscopy showed complete obstruction of the left mainstem bronchus with tumor that appeared to be originating from the secondary carina, and biopsies were diagnostic for a neuroendocrine tumor. We planned for a potential sleeve lobectomy, but the possibility of a parenchyma-sparing resection of the secondary carina was discussed. A completely portal technique using four robotic arms was utilized. Mediastinal lymph node dissection was performed. The superior and inferior pulmonary veins and left mainstem bronchus were mobilized. A portion of the left main stem bronchus was removed, resulting in discontinuity of the left upper and lower bronchi and mainstem bronchus. Frozen sections of the margins were negative. We reconstructed the secondary carina by creating a common wall between the upper and lower lobe bronchi . The left lobe bronchus was then connected with the left mainstem bronchus, and the left upper lobe bronchus was then connected with the left mainstem bronchus, all with 3-0 PDS V-Loc suture. The three sutures met in the middle anteriorly, thus completing the reconstruction. Operative time was 280 minutes; console time was 193 minutes. The chest tube was removed and the patient was discharged on postoperative day 1. Pathology demonstrated a 2.1 cm T1cN0 stage IA3 typical carcinoid tumor. Nine lymph nodes were submitted and all were negative for tumor. Margins from the resection were negative.