Robotic Left Upper Lobe Sleeve in a Pediatric Patient

C. Crisafi. Yongue¹, R. Cerfolio^2
1NYU Langone, New York, New York ²New York Langone Health, New York, New York

Please explain the educational or technical point that this video addresses.: This video addresses the management of bronchial carcinoid tumors in pediatric patients and the technique needed to complete a left upper lobe sleeve robotically.

Please provide a 250 word summary of the surgical video being submitted.: This is a 13 year old male patient with no past medical history who presented with small volume hemoptysis. He was admitted to the PICU and was found to have a large left mainstem lesion obstructing the left upper lobe bronchial orifice with post obstructive complete atelectasis of the left upper lobe. He was taken to the OR and a right sided dual lumen tube was used. The lesion was identified on bronchoscopy. A left robotic approach was taken and after mediastinal lymph node dissection and weaning inhaled Fio2 to room air the bronchus was opened at the level of the mass. A 25G needle was used to help localize the mass prior to bronchial transection. 3, 6, 9 and 12 oclock bronchial margins were sent for frozen section. The mass was found to be encroaching into the left upper lobe thus a left upper lobectomy was completed. An end to end bronchial anastomosis was sewn with 4-0 stratafix suture and no stricture or leak was noted on bronchoscopy. The left lower lobe was noted to inflate at the end of the case. The patient's chest tube was removed post operative day one and he went home the same day. Final pathology showed a Grade 1 typical carcinoid tumor with no lymphovascular invasion.