Yan Yan, Jin Runsen, Chen Xiaoyan, Zhang Yajie, Li Hecheng
Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2024 Mar 29;13(3):654-665. doi: 10.21037/tlcr-23-819. Epub 2024 Mar 18.
Tracheobronchial schwannomas are extremely rare, which account for lower than 0.2% in all pulmonary tumors. In large part because of the rarity and insufficient reported clinical details, tracheobronchial schwannoma lacks guidelines or expert consensus for diagnosis and treatment, and the delay in diagnosis can range from months to years. The main treatment option is surgery. Endoscopic intervention can also be selected. An increasing number of thoracic surgery cases were performed on the robotic platforms in recent years. With their assistance, surgeons can accomplish the high technique required surgical procedures with ease.
In this case, a 48-year-old female had a history of shortness of breath for more than 1 year. The chest computed tomography (CT) and bronchoscopy examination revealed a new growth of nodule in the left main bronchus. The nodule was considered a schwannoma by transbronchial biopsy, which was removed by robot-assisted bronchial resection with primary anastomosis. The application of Da Vinci Si robotic surgical system benefited the process of this surgery. Pathology and immunohistochemistry results confirmed the diagnosis of schwannomas. The patient tolerated the treatment without any complications. No sign of recurrence was discovered at present, 6 months after the intervention.
We reported the first sleeve resection for bronchial schwannoma using Da Vinci robotic surgical system. The clinical details of tracheobronchial schwannoma should be revealed more specifically to achieve more systematic diagnosis and treatment.
气管支气管神经鞘瘤极为罕见，在所有肺部肿瘤中占比低于0.2%。很大程度上由于其罕见性以及临床报道细节不足，气管支气管神经鞘瘤缺乏诊断和治疗的指南或专家共识，诊断延迟可达数月至数年。主要治疗选择是手术。也可选择内镜干预。近年来，越来越多的胸外科手术在机器人平台上进行。在其辅助下，外科医生能够轻松完成技术要求高的手术操作。
在本病例中，一名48岁女性有1年多的气短病史。胸部计算机断层扫描（CT）和支气管镜检查显示左主支气管有一个新的结节状肿物。经支气管活检将该结节诊断为神经鞘瘤，通过机器人辅助支气管切除并一期吻合将其切除。达芬奇Si机器人手术系统的应用使该手术过程受益。病理和免疫组化结果证实为神经鞘瘤。患者耐受治疗，无任何并发症。干预6个月后，目前未发现复发迹象。
我们报道了首例使用达芬奇机器人手术系统进行支气管神经鞘瘤袖状切除术。应更具体地揭示气管支气管神经鞘瘤的临床细节，以实现更系统的诊断和治疗。
