World's First Single-Port Robotic Secondary Carinal Resection and Reconstruction in a Child Successfully Completed

Background

A 13-year-old boy developed persistent cough and fever two months prior to treatment, leading to the discovery of a bronchial tumor. Biopsy confirmed malignancy, identified as a bronchial carcinoid at the left secondary carina, which had caused significant pneumonia. Initial bronchoscopic intervention with argon knife helped relieve the pneumonia but left residual tumor. The patient was referred to the thoracic surgery department of The First Affiliated Hospital of Soochow University for definitive radical surgery to remove the tumor while preserving as much lung function as possible.

The department was hosting the 2025 Single-Port Robotic Lung Surgery Learning Class in Suzhou on July 29, 2025. During this event, the team addressed this complex pediatric case, which required innovative approaches due to the narrow anatomy in a child's chest and the lack of prior reported experience with this specific robotic technique in pediatric patients.

What was achieved

Zhao Jun, director of thoracic surgery, led the team in collaboration with Prof. Diego Gonzalez-Rivas and hospital colleagues including Huang Haitao to successfully complete the world's first single-port robotic secondary carinal resection and reconstruction in a child. The procedure utilized the da Vinci Xi system through a single 4-cm incision in the fifth intercostal space along the midaxillary line. The secondary carina was resected with negative margins confirmed by intraoperative frozen section pathology, and airway continuity was restored.

The patient's postoperative course was uneventful. Left lung ventilation recovered rapidly, with the child able to get out of bed on the first postoperative day. Bronchoscopy performed three months later confirmed a patent and well-healed anastomosis without stenosis or granulation. Pathology confirmed typical bronchial carcinoid with no lymph node metastasis. This case was published in a peer-reviewed journal demonstrating feasibility and safety.

How it works

The secondary carina is the ridge-like structure where the left upper and lower lobe bronchi branch from the main bronchus. A tumor located there requires precise removal of the diseased segment of airway and reconstruction to reconnect the healthy bronchial portions, preserving ventilation to both lung lobes without lobectomy.

In the uniportal robotic approach using the da Vinci Xi system, all instruments and the camera are inserted through one small incision. The surgeon operates from a console with a magnified high-definition three-dimensional view of the field. Robotic arms offer seven degrees of freedom for wrist-like dexterity within the limited pediatric thoracic space, along with tremor filtration for precision. After resection of the secondary carina, reconstruction was completed using three separate continuous 3-0 barbed sutures. This method reduces incision size, tissue trauma, pain and scarring compared to traditional open thoracotomy.

What it means for international patients

The First Affiliated Hospital of Soochow University has an international medical department offering services to overseas patients, including VIP facilities, English medical records, professional translators, and dedicated international wards. The hospital has partnerships with over 30 international institutions and frequently collaborates with foreign experts, as seen in this case with Prof. Gonzalez-Rivas, who has served in an overseas director role for single-port robotic training at the hospital. Its thoracic surgery team has developed expertise in advanced single-port robotic procedures and hosts international training classes.

This procedure illustrates the availability of advanced minimally invasive options for complex pediatric thoracic conditions at the facility. International patients interested in similar care must confirm their eligibility, specific medical suitability, and current availability directly with the hospital's international department, as individual cases require thorough evaluation by the clinical team.

About the hospital

The First Affiliated Hospital of Soochow University is a Grade A tertiary hospital in Suzhou, Jiangsu Province, China. Founded in 1883 by the American Methodist Episcopal Church, it is affiliated with Soochow University and functions as a provincial key hospital and the medical guidance center for southern Jiangsu. It features approximately 3,000 beds across its campuses on Pinghai Road and Shizi Street, 37 clinical departments, and more than 4,000 employees.

The hospital has national key clinical specialties including in hematology and orthopedics, with thoracic surgery recognized as a national clinical key specialty construction project. The thoracic surgery department specializes in minimally invasive techniques such as single-port thoracoscopy and robotics, complex airway and lung operations, and hosts international surgical training workshops. It provides targeted services for international patients through its dedicated department.