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Background. The use of the surgical robot for standard lobectomy has widely spread worldwide. However there are relatively few studies of robotic bronchial sleeve lobectomy for central lung tumors.Methods. We retrospectively evaluated 67 consecutive patients who underwent robotic bronchial sleeve lobectomy, a procedure without pulmonary vessel end-to-end anastomosis, performed by a single surgeon between October 2014 and March 2018. A half-continuous suture technique with two Prolene (Ethicon, Inc, Somerville, NJ) sutures for bronchial anastomosis was applied. The operative techniques and outcomes were analyzed.Results. Complete resection was achieved in all patients undergoing different types of robotic bronchial sleeve lobectomy. There were no conversions to thoracotomy. The mean total surgical duration was 166.5 minutes (range, 78-286), total bronchial anastomosis time was 20.8 minutes (range, 10-44), estimated blood loss was 98.8 mL (range, 20-300), and postoperative hospital stay was 6.8 days (range, 4-13). No patient died within 90 days after surgery. The postoperative morbidity rate was 20.9%. Multivariate analysis showed that preoperative comorbidity, older age, and surgeon's early experience were risk factors for postoperative morbidity.Conclusions. Robotic bronchial sleeve lobectomy and the novel anastomotic technique are both feasible and safe for carefully selected patients.

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Double-sleeve lobectomy, which includes bronchoplasty and pulmonary arterial angioplasty, is required for certain cases of central-type lung cancer. It is usually done by open surgery or video-assisted thoracoscopic surgery (VATS). In recently, da Vinci system and robotic surgery have been applied in such complicated cases. Here we describe the details associated with robotic-assisted double-sleeve lobectomy.