Dual Suturing Technique Without Tying for Closure of the Bronchial Stump in Robotic Surgery

In lung cancer surgery, when tumors are present in the branches of the bronchus, it may be appropriate to perform suture closure by sharply separating the bronchus, rather than using an autosuture device to ensure adequate margins. While RATS simplifies needle handling compared to VATS, ligation remains challenging due to the lack of tactile feedback. To ensure closure of the bronchial segment by ligation in robotic surgery, we started a preliminary study to use dual barbed sutures that do not require ligation and clips for ligature fixation after the approval from the Ethics Committee of Mie University Hospital. We performed this procedure in five patients from January 2024 to present. Postoperative bronchoscopy, performed in four of the five patients, confirmed the bronchial stump was well closed in all cases, with no evidence of bronchopleural fistula (BPF). However, two patients experienced prolonged hospitalization due to midlobar torsion and prolonged air leakage requiring pleurodesis, respectively. The preliminary results suggest that this novel technique provides reliable bronchial stump closure in RATS. We plan to conduct a larger cohort study with long-term follow-up to further confirm the safety and long-term BPF rate.