Robotic sleeve lower lobectomy

Sleeve lobectomy was originally designed as an alternative to a pneumonectomy in patients with impaired pulmonary function. Many studies have shown that sleeve lobectomy is comparable to a pneumonectomy in terms of oncologic efficacy, morbidity, mortality, and long-term survival. In addition, presumably by preserving lung function and decreasing the complications that are inherent to a pneumonectomy, sleeve lobectomy has been shown to be superior to a pneumonectomy in terms of complications and quality of life. Sleeve lobectomy is indicated in all patients with N0 and selected N1 disease in whom the tumor extends past the bronchial orifice of the lobe. Sleeve lobectomy has been reported by minimally invasive techniques. However, the bronchial anastomosis is quite cumbersome when performed by conventional video-assisted thoracic surgery (VATS). The robotic surgical platform by virtue of magnified 3-dimensional visualization, ease of preparation of the bronchial stumps and setup of the anastomosis, and wristed instrument maneuverability in a confined space, enables sleeve lobectomy using minimally invasive techniques. Robotic sleeve lobectomy has been reported with excellent results. The technical principles and dissection with robotic sleeve lobectomy are the same as those of open surgery. Patient selection and extensive experience with lung resection using the robotic platform are mandatory to perform these complex and rare procedures. This article outlines the technical aspects of performing a robotic sleeve lower lobectomy.