Robotic Ligation of a Pulmonary Arteriovenous Malformation in a Teenaged Child: A Case Report

Introduction: Pulmonary arteriovenous malformations (PAVM) present with a variety of clinical manifestations, including hemoptysis. The usual management strategy relies upon interventional techniques, with surgery reserved for cases which are recalcitrant to less invasive measures.Case presentation: A 14-year-old female presented with massive and refractory hemoptysis. CTA and bronchoscopy did not identify a targetable lesion, but given her clinical instability she underwent percutaneous angiography which identified a right-sided PAVM with bronchial artery to pulmonary artery communication coursing near the right mainstem bronchus. Embolization procedures were initially successful to control bleeding, but recurrences of hemoptysis prompted surgical evaluation. Approximately two years after initial presentation, we performed robotic ligation of her PAVM which resulted in definitive control of the lesion with no additional bleeding episodes. She recovered well from surgery with a one-night hospital stay, and has experienced no surgical complications or recurrent bleeding to date.Conclusion: Rarely, pediatric PAVMs may require surgical intervention if interventional methods do not achieve definitive therapy. A variety of surgical techniques may be employed as dictated by the lesion's characteristics. Robotic approaches, including ligation, should be considered for patients with failure of conservative measures as it provides minimally invasive, precise technical management of PAVM.