ArticleJournal of visualized surgery2026
Uniportal robotic-assisted left upper lobectomy with pulmonary artery reconstruction for a central lung cancer: a step-by-step surgical technique.
Article in Journal of visualized surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Uniportal robotic-assisted thoracic surgery (uRATS) has emerged as an advanced minimally invasive platform for complex pulmonary resections. However, its application to centrally located lung cancers requiring vascular reconstruction following neoadjuvant chemo-immunotherapy remains technically demanding. We present a detailed surgical technique of uniportal robotic-assisted left upper lobectomy with intrapericardial venous division, bronchial transection for exposure, and pulmonary artery (PA) resection and reconstruction in a 70-year-old male with centrally located squamous cell carcinoma. The initial clinical stage was cT4N2M0. Following four cycles of neoadjuvant chemo-immunotherapy, restaging demonstrated residual soft-tissue density closely abutting the PA, with positron emission tomography-computed tomography (PET-CT) maximum standardized uptake value (SUVmax) of 2.71, consistent with residual viable tumor. Through a 4 cm uniportal incision, intrapericardial control of the left upper pulmonary vein was achieved. Due to obliteration of the PA-bronchus plane, early bronchial transection was performed to facilitate safe arterial exposure. The apicoanterior PA trunk was resected under temporary occlusion (total clamp time 26 minutes) and reconstructed using a continuous 5-0 Prolene suture. Estimated blood loss was 100 mL, and no transfusion was required. The postoperative course was uneventful. Final pathology demonstrated a complete pathological response (ycT0N0M0). This case illustrates that, in experienced hands, uRATS can be successfully applied to complex central tumors requiring bronchovascular reconstruction after neoadjuvant therapy.
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