Robotic Bronchial Restapling After Inadvertent Stapling of an Endobronchial Suction Tube: Technical Note and a Prestapling Time-Out.

Abstract

Foreign body entrapment during bronchial stapling is rare but may result in severe airway injury. We report an unusual intraoperative complication during robot-assisted thoracic surgery (RATS) lobectomy: inadvertent stapling of an endobronchial suction tube into the right lower lobe (RLL) bronchus, successfully managed robotically without conversion. A 65-year-old woman with clinical stage I lung adenocarcinoma underwent RATS RLL lobectomy with mediastinal lymph node dissection. During bronchial division, an endobronchial suction tube used to facilitate lung deflation was incorporated into the staple line. The tube was removed through limited resection of the involved bronchial stump segment, followed by traction-suture-assisted restapling. The postoperative course was uneventful, and 1-year follow-up showed no atelectasis and a patent right middle lobe bronchus with mild narrowing. When an adequate bronchial margin remains, robotic bronchial restapling may provide a feasible rescue option without conversion. A focused "pre-stapling time-out" to confirm the removal of endobronchial adjuncts may help prevent similar events.