Robotic-assisted lobectomy is becoming the surgical approach of choice for lung cancer. The safety of robotic lobectomy has been demonstrated extensively. Despite this, intraoperative injury to the pulmonary artery (PA) or PA branches is currently managed by conversion to thoracotomy. We present a case of arterial injury during a left upper lobectomy without conversion to thoracotomy.
Patient is a 37-year-old female with a 1.6 cm left upper lobe nodule (cT1bN0M0 adenocarcinoma) brought to the OR and placed in position for a standard 4-port complete portal robotic lobectomy (RPL-4). After dividing the inferior pulmonary ligament, posterior hilar and subcarinal lymph node dissections were completed. The patient had an incomplete and thickened fissure. During dissection of the lingular PA branch, an injury to an adjacent PA branch was made. Hemostasis was obtained with gentle pressure and placement of a vessel loop tourniquet around the proximal left main PA. The tourniquet allowed for proximal vascular control in case of continued bleeding. We were able to safely complete the case without conversion to thoracotomy. The patient tolerated surgery well with an estimated blood loss of 50 mL and no transfusion requirement. She was discharged home on post-op day #2. At her follow up appointment the patient was well and had returned to work and her baseline functional status.