In Japan, sleeve lobectomy with bronchial reconstruction accounts for only a small proportion of all lobectomies, making it difficult to acquire sufficient technical proficiency through clinical experience alone. Therefore, structured off the job training is considered important. We have developed a training method for sleeve resection using a high-fidelity, life-sized three-dimensional (3D) airway model reconstructed from computed tomography (CT) data. Recently, robotic-assisted sleeve lobectomy has been increasingly reported. Although robotic systems provide enhanced instrument dexterity, bronchial reconstruction under robotic assistance presents specific challenges, including the lack of tactile feedback, a restricted operative field inherent to minimally invasive surgery, and the need for careful management of suture length, tension, and anastomotic technique. Even experienced surgeons may encounter approach-specific pitfalls, underscoring the importance of adequate preoperative preparation. To address these issues, the 3D model was further refined by incorporating a chest wall module that reproduces the minimally invasive surgical environment, enabling realistic robotic-assisted training. Various continuous suturing techniques, including those using short double-armed needles or absorbable barbed sutures, can be practiced in a dry-laboratory setting. This training system allows repeated practice with easy access, independent of time and location, and may contribute to improved technical skills and procedural safety in robotic-assisted sleeve lobectomy.
A woman in her 40s was referred to our department with segmental emphysematous lesion in the right lower lobe, which were incidentally detected on computed tomography (CT) performed for another disease. She had experienced a brief episode of cough and right chest pain one year earlier, which resolved spontaneously. CT revealed interruption of the B10 bronchus, a dilated bronchus not communicating with the normal airway, fluid retention, and surrounding emphysematous lesion, suggesting bronchial atresia. Given the previous episode suggested an infection and the risk of recurrence, a robot-assisted basilar segmentectomy was performed for diagnostic and therapeutic purposes. Histopathological examination confirmed bronchial atresia with interruption of the B10 bronchus. A mild postoperative air leak occurred but resolved spontaneously, and the patient was discharged in good condition.
A 66-year-old man developed a bronchopleural fistula on postoperative day nine following video-assisted thoracoscopic right middle and lower lobectomy for right lower lobe lung cancer. An open window thoracostomy was performed on postoperative day 19. The fistula measured approximately 1 cm in diameter, and to achieve reliable closure, a right completion pneumonectomy was performed on postoperative day 56. Intraoperatively, the pleural cavity was covered with thickened granulation tissue, making anatomical identification difficult. Given the presence of infection, the procedure carried a high risk of complications such as bleeding and recurrence of bronchopleural fistula. To ensure safety, proximal vascular control was secured, and the bronchial stump was covered with an omental flap. During a three-year postoperative follow-up, no recurrence or complications were observed. Completion pneumonectomy following open window thoracostomy is extremely rare and carries high risk, thus requiring thorough preoperative planning and intraoperative preventive strategies.
We report a case of hemoptysis due to pulmonary artery pseudoaneurysms controlled by transcatheter arterial embolization (TAE) and surgery. An 83-year-old man presented with hemoptysis one month after treatment for pneumonia and referred to our hospital. Chest computed tomography( CT)revealed a lung abscess in the left lower lobe and two pulmonary artery pseudoaneurysms by the abscess. TAE was performed to control hemoptysis, and the hemoptysis improved. After his general condition improved, a left lower lobectomy was safely performed.
The infected brachiocephalic arterial aneurysm is a very rare but highly lethal, life-threatening, and difficult-to-treat condition. We report a case of infected brachiocephalic arterial aneurysm involving ascending aorta. An 81-year-old woman with a history of colon diverticulitis was referred to our hospital because of infected brachiocephalic aneurysm. Emergent operation was performed because the aneurysm grew rapidly. The aneurysm was excised, extra-anatomical grafting was performed with a prosthetic vascular graft and the ascending aorta was repaired with bovine pericardium patch. The aortic infection was successfully cured postoperatively, but she died of peritonitis. Due to the rarity, history-taking and physical examination should be thorough, and symptoms and signs should be closely analyzed.
