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RESEARCH PRODUCT

P111 ROBOTIC-ASSISTED REPAIR OF IATROGENIC LEFT BRONCHUS PERFORATION DURING RAMIE – A CASE REPORT

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Abstract Background Iatrogenic bronchial injury during an esophageal surgery is a severe complication. Hence, immediate treatment is necessary to avoid further pulmonary complications and death. We present a case of an intraoperative bronchial injury caused by a bronchial tube cuff during a full robotic-assisted Ivor-Lewis esophagectomy (RAMIE). Case report A 64-year old patient with adenocarcinoma of the distal esophagus was planned for a RAMIE after completing neoadjuvant radiochemotherapy. Before beginning the thoracic phase, the anesthesist reported an airway leakage during the ventilation. During the transthoracic robotic assisted esophagectomy a perforation of the left main bronchus caused by the cuff of the double-lumen tube was found. Due to the diameter of the defect (1/2 inch) direct suturing was not possible. Therefore, we used a stalked pericardial patch to robotically oversew the perforation. The precise agility using the robotic DaVinci system was very useful treating this perforation minimally- invasively during the RAMIE without conversion. The rest of the surgery including the gastric pull-up and intrathoracic anastomosis was carried out without further complication. The patient had a normal postoperative course and showed no signs of any pulmonary restrictions or any other morbidity. The patient was discharged fully enteralised and in good conditions at the 9th postoperative day. The histopathological stage was ypT3, N2(4/21), L0, V0, Pn0, R0 (stage IIIB in 7th UICC). Conclusion This case report points out the great possibilities of robotic surgery dealing with unexpected complications during complex operations. Robot-assisted complex suturing is a great advantage in robot-assisted minimally invasive surgery, especially during sewing a pericardium-flap onto the left bronchus perforation during an esophagectomy.