Completely robotic right Pancoast tumour resection with en bloc right upper lobectomy and chest wall resection using a high-speed pneumatic drill

Pancoast (superior sulcus) tumours continue to represent a demanding subset of thoracic malignancies, largely because of their close relationship with the thoracic inlet, and frequent encroachment on the upper ribs and surrounding neurovascular structures. Traditional operative strategies have relied heavily on extensive posterior or combined approaches to obtain the exposure required for chest wall control. Even as robotic minimally invasive lung surgery has matured, the technical constraints at the apex of the chest have limited the application of purely endoscopic methods for these lesions. Our team has developed broad experience with complex robotic lung resections and minimally invasive procedures involving the chest wall, which encouraged us to reconsider how robotic technology might be applied to Pancoast disease. In a patient with a tumour extending into both the second and third ribs, we aimed to complete the entire resection-including chest wall involvement-through a fully robotic set-up. By incorporating a high-speed drill under robotic visualization, we were able to divide the affected ribs entirely within the thoracic cavity, avoiding the need for additional incisions or hybrid access. The following case report outlines our operative strategy and key technical considerations.