Postoperative Ischemic Bronchitis Progressing to Bronchopleural Fistula After Robotic Lobectomy: A First Report.

Postoperative ischemic bronchitis (POIB) is a known precursor to bronchopleural fistula (BPF) after lung resection with systematic lymphadenectomy, occurring in 2.5%-3.2% of cases, yet has only been reported following open thoracotomy. We report a case of POIB progressing to BPF following robotic lobectomy. A 51-year-old male underwent robotic-assisted right lower lobectomy with systematic lymph node dissection for stage IB lung adenocarcinoma. Three weeks postoperatively, he developed dyspnea and hemoptysis. Diagnostic bronchoscopy revealed transmural necrosis of the right mainstem bronchus (a 2.5 × 4 cm defect with grade 4-5 ischemic changes) which required surgical repair. Follow-up bronchoscopy confirmed complete healing. As robotic lobectomy enables more extensive lymphadenectomy than conventional approaches, pulmonologists should recognize POIB as a potential complication. Systematic postoperative bronchoscopy between days 7 and 12 should be considered in high-risk patients, as 80% of POIB cases are asymptomatic and early detection may prevent progression to BPF.