Bronchial sleeve anastomosis and primary closures with the da Vinci system: an advanced minimally invasive technique

Tugba Cosgun, Erkan Kaba, Kemal Ayalp, Mazen Rasmi Alomari, Alper Toker


Background: Bronchial division using a stapler may lead to a positive or suboptimal bronchial margin during anatomical resections if the tumour is close to the lobar orifice. Primary suture closure of the bronchus, instead of stapling, or bronchial sleeve anastomosis may provide a better marginal distance in such cases. One of the advantages of minimally invasive robotic surgery (da Vinci System Intuitive Surgical, Sunnyvale, CA, USA) is the complete transfer of surgeon’s capability inside the thoracic cavity. In this study, we analysed primary bronchial closure or bronchial anastomosis techniques performed using robot-assisted thoracoscopic surgery (RATS).
Methods: In total, 296 patients underwent robot-assisted thoracoscopy in our centre between January 2012 and June 2017. Among these, 203 underwent anatomical lung resections. Surgical bronchial closure techniques were performed on nine patients. The indications for bronchial closure, details of surgery and peri- and postoperative characteristics were analysed in this study.
Results: We performed primary suture closure in three patients, sleeve lobectomy in five and isolated partial bronchotomy and bronchial closure in one. Although we used prolene sutures in the first three patients, we preferred to use V-loc sutures (barbed sutures; Medtronic, Covidien New Haven, CT, USA) in the more recent patients. The mean docking time was 16.3±5.8 min (range, 10–25 min), and the mean operation duration was 101.1±24.2 min. The duration of drainage was 3.6±1 days, and the mean length of postoperative stay in hospital was 6.2±1.6 days. All patients underwent R0 resections.
Conclusions: Bronchial closure without staplers is a safe method in experienced hands in robotic surgery. Negative surgical margins of the bronchus can be achieved in lung tumours that are close or extending over the lobar bronchus by higher technical capabilities of robotic surgery. We believe V-loc sutures have a potential place in bronchial closure in minimally invasive surgery.