Pulmonary artery repair during robotic lung resection: narrative review and management

Minimally invasive surgery is currently the standard of care for the surgical management of early -stage lung cancer. The generalization of robotic and video -assisted thoracic surgery (VATS) for lung cancer resection, emphasize the problem of the management of major intraoperative complications. Here in, we report our experience regarding the management of major bleeding occurring during robotic lung cancer resection. We sought to define an appropriate approach to manage pulmonary artery injury (PAI) and to prevent the occurrence of vascular injury. The intraoperative management of these injuries is based on crisis scenario that must be repeated and prepared beforehand including the whole team of anesthesiologist and nurses, highlighting the role of team communication. Moreover, it emphasizes the function of the assistant who is close to the patient; he had to help the main surgeon to control the bleeding before the main surgeon can perform conversion thoracotomy if the vessel could not be repaired robotically. Moreover, we reported the different methods of prevention of vascular injuries that need to be taught. Prevention is based on surgical and case control simulation with the whole team in the operating room, training with robot simulators to improve technical aspects and preoperative planning using 3 -dimensional imaging to investigate more precisely the disposition of the pulmonary arteries and veins.