Robotic-assisted resection of intralobar and extralobar pulmonary sequestration

摘要

Central MessageRobotic resection of pulmonary sequestration, both intralobar or extralobar, is a feasible and safe less-invasive surgical procedure reducing the risk of intraoperative complications. Pulmonary sequestration (PS) is a rare pulmonary anomaly characterized by the presence of a nonfunctional pulmonary tissue and supplied by aberrant vessel(s) arising from the systemic circulation. There are 2 types of PS, depending on whether the presence of pleural covering: intralobar PS (75% of sequestrations), located within normal pulmonary parenchyma without pleural covering, and extralobar PS (25% of sequestrations), separated from the normal lung with its own pleura covering. Despite being a benign lesion, the associated complications, which include recurrent sepsis and hemoptysis, can be serious. Surgical resection is the treatment of choice for any type of PS. In the past, thoracotomy was the main surgical approach; nowadays, less-invasive techniques are widely accepted as a valid surgical option proving to be safe, feasible, and effective; nevertheless, few reports described the use of robotic approach for PS.1Al-Mufarrej F. Margolis M. Tempesta B. Gharagozloo F. Robot-assisted thoracoscopic resection of intralobar sequestration.J Laparoendosc Adv Surg Tech. 2009; 19: 389-391Crossref PubMed Scopus (7) Google Scholar, 2Melfi F.M. Viti A. Davini F. Mussi A. Robot-assisted resection of pulmonary sequestrations.Eur J Cardiothorac Surg. 2011; 40: 1025-1026PubMed Google Scholar, 3Gulkarov I. Ciaburri D. Tortolani A. Lazzaro R. Robotic-thoracoscopic resection of intralobar sequestration.J Robot Surg. 2012; 6: 355-357Crossref PubMed Scopus (1) Google Scholar, 4Konecna J. Karenovics W. Triponez F. Robot-assisted segmental resection for intralobar pulmonary sequestration.Int J Surg Case Rep. 2016; 22: 83-85Crossref PubMed Scopus (7) Google Scholar, 5Dagorno C. Sarsam M. Brun A.L. Longchampt E. Sage E. Chapelier A. et al.A horseshoe intralobar lung sequestration resection by bilateral robot-assisted surgery.Ann Thorac Surg. 2022; 113: e95-e97Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We report 2 cases of robotic-assisted resection of PS, intralobar and extralobar, respectively, the latter being the first report with this approach. An institutional review board exemption was obtained for this retrospective review and the patients provided informed consent. A 38-year-old male patient was diagnosed with a left lower-lobe (LLL) intralobar sequestration on computed tomography (CT) of the chest performed for hemoptysis. A contrast-enhanced CT scan confirmed PS measuring 46 mm and identified 4 aberrant arteries arising from the descending aorta (Figure 1). The surgical procedure (Video 1) was a 4-arm approach by the Xi DaVinci (Intuitive Surgical). Pleural adhesions were liberated and pulmonary ligament was divided. A total of 5 anomalous arteries were isolated: 4 were transected using an EndoWrist stapler (Intuitive Surgical), and one was transected after applications of Hem-o-lok (Teleflex). A segmental resection was performed and the resected sample was extracted with the use of an Endo Bag (Medtronic). Operative time was 110 minutes. The patient was discharged the third postoperative day without complications. Histology confirmed intralobar sequestration. The patient was well at the 14-month follow-up evaluation. A 41-year-old male patient was diagnosed with an intrathoracic triangular mass incidentally discovered on a check-up CT of the chest. A contrast-enhanced CT scan diagnosed an extralobar PS (70 mm) with a dense central core (38 mm) and identified a small aberrant artery arising from the intrabdominal aorta (Figure 2, A). Our surgical approach (Video 2) was similar to the previous one. Extralobar lesion appeared as a pedunculated lumpy mass covered on the surface by a dense vascular network (Figure 2, B) with a soft pedicle and dense adhesions (Figure 2, C). The pedicle was isolated, transected by an Endo