# Robot-assisted lung segmentectomy in a patient with an implantable left ventricular assist device: a case report

## TL;DR

A patient with a heart pump and lung cancer successfully had a robot-assisted lung surgery before heart transplant.

## Contribution

Demonstrates successful robot-assisted lung surgery in a patient with an LVAD, enabling subsequent heart transplantation.

## Key findings

- Robot-assisted thoracoscopic segmentectomy was safely performed in a patient with an LVAD.
- The patient underwent heart transplantation after successful lung cancer surgery.
- Intraoperative hemodynamic monitoring was effectively managed during the procedure.

## Abstract

Survival can be prolonged in patients with end-stage heart failure using left ventricular assist devices (LVADs); however, increased longevity raises the risk of developing noncardiac complications, including malignancies requiring surgery.

A 58-year-old man with an LVAD was referred for the diagnosis and treatment of an undiagnosed nodule in the right upper lobe, which was detected during a preoperative computed tomography (CT) scan, for heart transplantation assessment. CT revealed a 9-mm nodule in the right anterior segment (S3), and an 18F-fluorodeoxyglucose positron emission tomography showed significant uptake, suggestive of lung cancer. A robot-assisted thoracoscopic right S3 segmentectomy was performed. Intraoperative hemodynamic monitoring included an arterial line, a central venous catheter, a pulmonary arterial catheter, and transesophageal echocardiography. The procedure was completed successfully without complications. Pathological analysis confirmed adenocarcinoma, classified as pathological stage T1aN0M0 (Stage IA1). The patient subsequently underwent heart transplantation and LVAD removal on postoperative day 185.

A patient with lung cancer and an LVAD who was awaiting heart transplantation successfully underwent robot-assisted thoracoscopic right S3 segmentectomy, enabling him to subsequently undergo a heart transplant.