General Thoracic Video Session: Highlights and Innovations II
Robotic Pulmonary Artery Sleeve for Central Right Middle Lobe Tumor
Sunday, January 26, 2025
8:48am – 8:56am PT
Location: 411 Theatre
C. Crisafi. Yongue1, M. Zervos1, R. Cerfolio2 1NYU Langone, New York, New York 2New York Langone Health, New York, New York
Disclosure(s):
Camille Crisafi Yongue, n/a: No financial relationships to disclose
Please explain the educational or technical point that this video addresses.: This video demonstrates how to use a robotic technique for a centrally located lung tumor requiring a pulmonary artery sleeve resection.
Please provide a 250 word summary of the surgical video being submitted.: A 66-year-old male current smoker for 40 years with a history of anemia and coronary artery disease with stents presented for a right middle lobe spiculated central perihilar nodule measuring 2.5 x 1.5 cm on CT with hilar adenopathy on PET. Endobronchial ultrasound was negative. After tumor board discussion he presented for a robotic right middle lobectomy possible pulmonary artery sleeve. A mediastinal lymph node dissection was done including levels 9, 8, 7, 11, 4 and 2. It was evident that the tumor in the middle lobe was very close to the pulmonary artery and the bronchus from the minor fissure. As such we could not get around the pulmonary artery at this level so we dissected between V2 of the upper lobe and the middle lobe through the fissure. This allowed us to access a pulmonary artery branch to the middle lobe but the remaining part of the A 4-5 and the artery going to the lower lobe were very close to the tumor. Thus, an end-to-end sleeve of the pulmonary artery was performed after getting proximal control on the artery and distal control on the inferior pulmonary vein. Using a 5-0 Gore-Tex suture a running end-to-end anastomosis was sewn from the back wall. Two pieces of TachoSil were placed on the front and back of the repair. ICG was administered and perfusion of the remaining upper and lower lobes was confirmed. A small part of segment 8 did not perfuse and was removed.
Learning Objectives:
Upon completion, participant will be able to describe how to perform a pulmonary artery sleeve resection robotically.
Upon completion, participant will be able to describe the appropriate indications for pulmonary artery sleeve resection.