[Challenges and Technical Solutions in Dual-port Robotic-assisted Right Upper Sleeve Lobectomy:a Case-based Experience].

BACKGROUND

Robot-assisted thoracic surgery (RATS) provides a stable magnified three-dimensional view and precise instrument control, and its application to complex procedures such as bronchial reconstruction has expanded worldwide. Dual-portal RATS, as a reduced-port approach, offers advantages in minimal invasiveness but presents specific challenges, including limited assistant working space and robotic arm interference.

CASE PRESENTATION: A 77-year-old man with suspected primary lung cancer underwent right upper lobectomy using dual-portal RATS. Intraoperatively, severe adhesion of hilar lymph nodes to the upper lobe bronchus suggested extranodal invasion, requiring bronchial sleeve resection. Bronchial reconstruction was successfully completed using continuous suturing with barbed sutures under robotic assistance.

RESULTS

The postoperative course was uneventful, and the patient was discharged on postoperative day 4. While robotic assistance enabled precise bronchial suturing, technical difficulties related to assistant maneuverability and arm interference were encountered, particularly during bronchial anastomosis.

CONCLUSIONS

Based on early experience with reduced-port RATS, we established practical principles to minimize arm interference and emphasize team-based training, including simulation. With appropriate technical refinement and education, dual-portal RATS may represent a feasible and safe approach for complex bronchial reconstruction.