Two different methods of bronchial dissection and coverage in robotic bilobectomy for advanced lung cancer.

Introduction: Due to its many technical advantages, the scope of robot‐assisted thoracic surgery (RATS) is expanding to include extended pulmonary resection. Among such procedures, right bilobectomy is one with a high risk of inducing development of a bronchial stump fistula. Materials and Surgical Technique: The pericardial fat pad case involved a 71‐year‐old man with a 31‐mm adenocarcinoma in the right lung that had progressed to the intermediate bronchus. During lower bilobectomy, to confirm the tumor margin, an L‐shaped stapler was used with stapling only at the oral side, and the bronchus was cut using a scalpel blade grasped with robot forceps. After confirming a negative stump, the pericardial fat was collected at the pedicle and sewn onto the stump. The intercostal muscle (ICM) flap case involved a 61‐year‐old man with a 16‐mm nodule shadow in the lower lobe of his lung and swollen #11i and 7 lymph nodes. Intraoperatively, the #7 lymph node was diagnosed as non‐small‐cell lung cancer by frozen sections, and lower bilobectomy was performed. The bronchus was divided using a stapler with a green cartridge, and the ICM flap was harvested by changing the direction of the camera to a look‐up view and positioning the camera at the 5th intercostal site. His numeric rating score (NRS) at 30 and 90 days post‐surgery was 2 and 0, respectively. Discussion: Our RATS technique was useful for harvesting the ICM flap. More cases should be accumulated to extend the surgical indication for RATS. [ABSTRACT FROM AUTHOR]