2021 Volume 35 Issue 6 Pages 699-704
The Japanese national health insurance program has covered robot-assisted lung resection since April 2018. The number of these resections has increased markedly, but there are few reports of complications. We report the case of a patient who developed postoperative bleeding related to robot-assisted lung resection. The patient was a 54-year-old male. We performed robot-assisted right-lower lobectomy and lobe-specific lymph-node dissection. The operation was completed as planned. However, hemorrhagic shock with massive bleeding occurred 6 hours after the surgery. We performed an emergent re-operation and found a massive hematoma. Bleeding from the artery in front of the vertebral body was observed and was stopped by suturing. We considered that this hemorrhage was caused by contact with the robot instrument-vertebral body outside of the video monitor display area. CO2 insufflation caused exclusion of the posterior mediastinum, and the angle of the robot forceps became steep. In the near field of view, we did not visually detect instrument-vertebral body contact. We also could not recognize vertebral compression by the robot instrument because of a lack of tactile feedback, and the CO2 insufflation had suppressed the bleeding temporarily. This case illustrates the importance of understanding the differences in characteristics between conventional surgery and robot-assisted surgery and of anticipating potential problems.
