BACKGROUND: Intraoperative catastrophes during robotic anatomical pulmonary resections are potentially devastating events. The present study aimed to assess the incidence, management, and outcomes of these intraoperative catastrophes for patients with primary lung cancers.

METHODS: This was a retrospective, multi-institutional study that evaluated patients who underwent robotic anatomical pulmonary resections. Intraoperative catastrophes were defined as events necessitating emergency thoracotomy or requiring an additional unplanned major surgical procedure. Standardized data forms were collected from each institution, with questions on intraoperative management strategies of catastrophic events.

RESULTS: Overall, 1,810 patients underwent robotic anatomical pulmonary resections, including 1,566 (86.5%) lobectomies. Thirty-five patients (1.9%) experienced an intraoperative catastrophe. These patients were found to have significantly higher clinical TNM stage (p=0.031) and lower FEV1 (81% vs 90%, p=0.004). A higher proportion of patients who had a catastrophic event underwent preoperative radiotherapy (8.6% vs 2.3%, p=0.048), and the surgical procedures performed differed significantly compared to non-catastrophic patients. Patients in the catastrophic group had higher perioperative mortality (5.7% vs 0.5%, p=0.018), longer operative duration (195 min vs 170 min, p = 0.020), and higher estimated blood loss (225 ml vs 50 ml, p

CONCLUSIONS: The incidence of catastrophic events during robotic anatomical pulmonary resections was low, and the most common complication was pulmonary arterial injury. Awareness of potential intraoperative catastrophes and their management strategies are critical to improving clinical outcomes.