Bilateral uniportal robotic-assisted thoracic surgery sleeve lobectomy for a bilateral endobronchial lung cancer

Abstract

A 74-year-old male patient, ex-smoker, with chronic obstructive pulmonary disease (COPD) treated with inhaled steroids, presented with fever, dyspnea, and asthenia, lung hyperinflation on chest X-ray, normal blood tests, forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of 57.5%, FVC of 2.9l (80%), FEV1 of 1.67l (60%) and diffusing lung capacity for carbon monoxide (DLCO) of 62%. Computed tomography (CT), positron emission tomography-CT (PET-CT), and flexible bronchoscopy with biopsies diagnosed bilateral synchronous endobronchial squamous cell carcinoma (SqCC) of the bronchus intermedius [tumor =3.1 cm, standardized uptake value (SUV) =9.2] and left lower bronchus (tumor =2.5 cm, SUV =9.8). Invasive mediastinal staging was not considered. The patient was evaluated in another center, where they proposed a right middle and lower bilobectomy and radiotherapy of the left lung carcinoma; he requested a second opinion at our hospital. Considering our surgical experience, the patient's characteristics, and the imperious need for a radical, but lung-sparing, operation, after multidisciplinary discussion the patient was offered a bilateral sequential sleeve lobectomy using the newest robotic technique, uniportal robotic-assisted thoracic surgery (U-RATS)