Ion robotic bronchoscopy laser ablation and Da Vinci robotic segmentectomy for bilateral pulmonary nodules: a case report.

Abstract

Background: The treatment strategy of multiple pulmonary nodules presents significant challenges in thoracic surgery, particularly regarding precise diagnosis and treatment. The integration of emerging technologies for concurrent hybrid diagnostic and therapeutic approaches represents a potential breakthrough. The purpose of this study is to provide a new paradigm for the synchronous mixed treatment of multiple pulmonary nodules.

Case description: A 34-year-old female patient was initially diagnosed with multiple pulmonary nodules in August 2023 and has been undergoing regular follow-up since then. A computed tomography (CT) in September 2024 showed a mixed ground-glass nodule (mGGN) in the dorsal segment (S6) of the left lower lobe of the lung, measuring approximately 11 mm × 7 mm, indicating a high risk of malignancy; and a ground-glass opacity (GGO) measuring 5 mm × 4 mm between the dorsal segment and anterior basal segment (S6 and S8) of the right lower lobe, with both nodules showing enlargement compared to a year ago. A simultaneous bilateral lung surgery is planned. The Ion robotic system was utilized to navigate precisely to the lesion along the B6b bronchus of the right lower lobe, where the lung nodule was ablated with a laser. Subsequently, the Da Vinci robotic system used to assist in the precise resection of the S6. Pathology on the left showed adenocarcinoma; a CT one week postoperatively showed a 1 cm patchy shadow with a cavity on the right.

Conclusions: This report presents the first surgical technique for ion robotic-assisted laser ablation and dual-robot collaborative surgery, offering a novel strategy for the integration of airway diagnostic and therapeutic interventions.