Pulmonary bone marrow embolism caused by robot-assisted lobectomy: a case report.

Pulmonary bone marrow embolism is most strongly associated with trauma or chest compressions during cardiopulmonary resuscitation. Embolism associated with robot-assisted lung resection has not been previously reported. A female patient underwent left upper lobectomy with robot-assisted thoracic surgery for lung cancer. On postoperative Day 3, chest X-ray revealed a fracture on the dorsal side of the eighth rib. Her postoperative course was uneventful. Pathology of the resected lung revealed pulmonary bone marrow embolism. Owing to anatomical limitation in the mobility of the dorsal intercostal rib space, there is a risk of rib fracture by the metallic port of the robot. The path from the skin incision to the intercostal space should be directed straight towards the target anatomy, and attention should be given to the direction of movement of the most dorsal port during surgery to avoid rib fractures.