Right-Sided Robotic Resection of Left Mainstem Bronchus

In December 2024, surgeons at NYU Langone Health successfully resected an adenoid cystic carcinoma located in a patient’s proximal left mainstem bronchus using a fully robotic approach. The surgical team, led by cardiothoracic surgeon Robert J. Cerfolio, MD, MBA, accessed the tumor from the right chest, navigating around the aortic arch, while surgeon Stephanie H. Chang, MD, managed EMCO support.

The case is among several recent robotic airway resections on ECMO at NYU Langone, with fewer than ten such procedures reported worldwide, says Dr. Cerfolio. “We prefer to approach from the right chest for all proximal and mid left mainstem lesions,” says Dr. Cerfolio.

[Watch Dr. Cerfolio’s video presentation on the case here.]

The total operative time was 2 hours and 10 minutes, with the 73-year-old patient extubated in the OR and discharged the next day. The robotic approach avoided the need for a more invasive thoracotomy, which often involves extensive time in the hospital for recovery and chin-to-chest positioning to reduce tension on the airway anastomosis.

“We have a culture where it’s safe to innovate,” says Dr. Cerfolio. “Our surgeons have the confidence to pursue new approaches that provide better care and a better patient experience.”

Case Highlights

Early mobilization of the airway was key to reducing tension on the anastomosis, says Dr. Cerfolio. This began with freeing the right mainstem bronchus from the right chest, followed by mobilization of the distal trachea from the innominate artery and esophagus.

“The critical part of this operation is the premobilization of the airway long before you divide the airway,” he explains. “If you divide the airway first, you lose the ability to mobilize it.”

The 6 cm tumor extended into the carina. After resecting all visible disease, margins were sent for pathology. “The first margin had some positive tumor creeping down, so I had to take more tissue, which gives me more tension. But adenoid cystic carcinomas are common for these creeping lymphatics, so I knew that was coming,” says Dr. Cerfolio.

For anastomosis, interrupted 3-0 Vicryl sutures were used instead of prolene, with Dr. Cerfolio having found absorbable sutures to perform best for airway healing.

The patient will undergo a repeat bronchoscopy and CT scan at six months, followed by close surveillance.