What happened, in summary

A 66-year-old woman with no smoking history had an 18 mm nodule found in the S9 region of the right lower lung on chest CT. CT-guided biopsy showed lung adenocarcinoma. PET/CT also showed FDG uptake in the #11i lymph node, raising concern for nodal metastasis, so her preoperative stage was cT1bN1M0, Stage IIB. Preoperative imaging also found a 9 mm bronchial diverticulum, an airway outpouching, communicating with the right main bronchus just below the tracheal bifurcation. Because the planned lymph node dissection would occur near the diverticulum, the surgical team chose robotic thoracoscopic surgery for its fine instrument control. Bronchoscopy after intubation confirmed the diverticulum opening in the right main bronchus. During surgery, the tissue around the diverticulum was prone to bleeding, and nearby lymph nodes were difficult to separate. Surgeons exposed the stalk of the diverticulum and ligated it with an ENDOLOOP suture, which helped control bleeding and allowed safe lymph node removal. After dissection, the diverticulum was ligated again. The enlarged #11i lymph node showed no metastasis on frozen pathology. Surgeons then completed a right lower lobectomy and covered both the diverticulum and lower-lobe bronchial stump with pericardial fat tissue. She was discharged without postoperative complications. Final pathology found no lymph node metastases in the dissected nodes, and the diagnosis was downgraded to pT1bN0M0, Stage IA2. Chest CT 6 months after surgery showed no recurrence of lung cancer, although air remained in the diverticulum, suggesting a small persistent opening. After surgery, she continued follow-up without chemotherapy or radiation.