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Dong Z, Liu D, Cheng N, Wang X, Huang J, Li C, Liu J, Hu W. Advantages of robot-assisted resection of large mediastinal tumors: a single-center preliminary study. J Robot Surg 2024; 18:190. [PMID: 38693421 DOI: 10.1007/s11701-024-01958-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
Current study aims to assess the safety and efficacy of robot-assisted thoracoscopic surgery (RATS) for sizable mediastinal masses with a minimum diameter ≥6 cm, compared with video-assisted thoracoscopic surgery (VATS) and open surgery. This study enrolled 130 patients with mediastinal tumors with no less than 6 cm diameter in Zhongnan Hospital, Wuhan University, including 33 patients who underwent RATS, 52 patients who underwent VATS and 45 patients who underwent open surgery. After classifying based on mass size and whether it has invaded or not, we compared their clinical characteristics and perioperative outcomes. There was no significant difference in age, gender, mass size, myasthenia gravis, mass location, pathological types (p > 0.05) in three groups. Patients undergoing open surgery typically presenting at a more advanced stage (p < 0.05). No obvious difference was discovered in the average postoperative length of stay, operation duration, chest tube duration and average postoperative day 1 drainage output between RATS group and VATS group (p > 0.05), while intraoperative blood loss in RATS group was significantly lower than VATS group (p = 0.046). Moreover, the postoperative length of stay, operation duration, chest tube duration and intraoperative blood loss in RATS group were significantly lower than open surgery group (p < 0.001). RATS is a secure and efficient approach for removing large mediastinal masses at early postoperative period. In comparison with VATS, RATS is associated with lower intraoperative blood loss. Compared with open surgery, RATS is also associated with shorter postoperative length of stay, operation duration, chest tube duration and intraoperative blood loss.
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Affiliation(s)
- Zheng Dong
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
- Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan, 430071, People's Republic of China
| | - Daoquan Liu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Nitao Cheng
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Xianguo Wang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Jingyu Huang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Changsheng Li
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Jun Liu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Weidong Hu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.
- Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan, 430071, People's Republic of China.
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Ogihara A, Omata M, Shidei H, Mitsuboshi S, Aoshima H, Isaka T, Matsumoto T, Kanzaki M. Intraoperative robotic surgical system-related problems in robot-assisted thoracoscopic surgery. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02013-1. [PMID: 38438825 DOI: 10.1007/s11748-024-02013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/28/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Malfunctions of robotic instruments during robotic surgery are well known to occur; however, detailed reports on the inherent problems associated with robotic instruments and robotic surgical systems are scarce. The objective of this study was to retrospectively investigate the intraoperative problems associated with robotic surgical systems and robotic instruments. MATERIALS AND METHODS This was a single-center retrospective study. Between April 2012 and December 2022, 544 patients with consecutive lung malignancies and/or mediastinal tumors underwent robot-assisted thoracoscopic surgery. Among these, 15 cases had intraoperative problems associated with the robotic surgical system. Human error was defined as a problem caused by the incorrect operation of the robotic surgical system and human factors as problems in which the robotic surgical system stopped owing to damage to the instruments of the robotic surgical system or the self-diagnosis of the robotic surgical system. We retrospectively investigated the causes of intraoperative problems in these cases. RESULTS There were 4 cases (0.7%) with problems related to the robotic surgical system, 2 of which were human errors, and 11 (2.0%) with problems related to robotic surgical instruments, 6 of these were related to instruments and 5 were related to robotic staplers. Five of these were related to human factors. CONCLUSION Teams performing robot-assisted thoracoscopic surgery should be familiar with the features of robotic surgical systems and various robotic devices, be aware of reported problems during robot-assisted thoracoscopic surgery, and be prepared for emergencies.
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Affiliation(s)
- Akira Ogihara
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Motoka Omata
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Hiroaki Shidei
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Hiroe Aoshima
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Takako Matsumoto
- Center for Medical and Nursing Education, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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Berzenji L, Wen W, Verleden S, Claes E, Yogeswaran SK, Lauwers P, Van Schil P, Hendriks JMH. Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand? Cancers (Basel) 2023; 15:4281. [PMID: 37686557 PMCID: PMC10487098 DOI: 10.3390/cancers15174281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In the last two decades, robotic-assisted thoracoscopic surgery (RATS) has gained popularity as a minimally invasive surgical (MIS) alternative to multi- and uniportal video-assisted thoracoscopic surgery (VATS). With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception, hand-eye coordination, and freedom of motion of the instruments. Previous studies have shown that a robotic approach for operable lung cancer has treatment outcomes comparable to other MIS techniques such as multi-and uniportal VATS, but with less blood loss, a lower conversion rate to open surgery, better lymph node dissection rates, and improved ergonomics for the surgeon. The thoracic surgeon of the future is expected to perform more complex procedures. More patients will enter a multimodal treatment scheme making surgery more difficult due to severe inflammation. Furthermore, due to lung cancer screening programs, the number of patients presenting with operable smaller lung nodules in the periphery of the lung will increase. This, combined with the fact that segmentectomy is becoming an increasingly popular treatment for small peripheral lung lesions, indicates that the future thoracic surgeons need to have profound knowledge of segmental resections. New imaging techniques will help them to locate these lesions and to achieve a complete oncologic resection. Current robotic techniques exist to help the thoracic surgeon overcome these challenges. In this review, an update of the latest MIS approaches and nodule detection techniques will be given.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Wen Wen
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Stijn Verleden
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Erik Claes
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Suresh Krishan Yogeswaran
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Jeroen M. H. Hendriks
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
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Mitsuboshi S, Matsumoto T, Omata M, Shidei H, Ogihara A, Koen A, Aoshima H, Isaka T, Kanzaki M. Complete thoracoscopic S9 and/or S10 segmentectomy through a pulmonary ligament approach: a retrospective study. J Cardiothorac Surg 2023; 18:150. [PMID: 37069664 PMCID: PMC10111718 DOI: 10.1186/s13019-023-02256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The high resolution of computed tomography has found the pulmonary ligaments that consists of a double serous layer of visceral pleura, forms the intersegmental septum, and enters the lung parenchyma. This study aimed to investigate the clinical feasibility of thoracoscopic segmentectomy (TS) of the lateral basal segment (S9), posterior basal segment (S10), and both through the pulmonary ligament (PL). METHODS Between February 2009 and November 2021, 542 patients underwent segmentectomy for malignant lung tumors at Tokyo Women's Medical University Hospital (Tokyo, Japan). This study included 51 patients. Among them, 40 underwent a complete TS of the S9, S10, or both by the PL approach (PL group), and the remaining 11 by the interlobar fissure approach (IF group). RESULTS Patients' characteristics did not significantly differ between the two groups. In the PL group, 34 underwent video-assisted thoracoscopic surgery (VATS), and 6 underwent robot-assisted thoracoscopic surgery. In the IF group, all 11 underwent VATS. Operation duration, estimated blood loss, and postoperative complication frequency were not significantly different between these groups, but the maximum tumor diameter showed a significant difference. CONCLUSIONS Complete TS of the S9, S10, and both through the PL is a reasonable option for tumors located in such segments. This approach is a feasible option for performing TS.
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Affiliation(s)
- Shota Mitsuboshi
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takako Matsumoto
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Motoka Omata
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroaki Shidei
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akira Ogihara
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akihiro Koen
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroe Aoshima
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tamami Isaka
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masato Kanzaki
- The Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Li J, Liu X, Li J, Han D, Li Y, Ge P. Mechanism of andrographis paniculata on lung cancer by network pharmacology and molecular docking. Technol Health Care 2023:THC220698. [PMID: 36641698 DOI: 10.3233/thc-220698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Traditional Chinese medicine (TCM) has been widely recognized and accepted worldwide to provide favorable therapeutic effects for cancer patients. As Andrographis paniculata has an anti-tumor effect, it might inhibit lung cancer. OBJECTIVE The drug targets and related pathways involved in the action of Andrographis paniculata against lung cancer were predicted using network pharmacology, and its mechanism was further explored at the molecular level. METHODS This work selected the effective components and targets of Andrographis paniculata against the Traditional Chinese Medicine System Pharmacology (TCMSP) database. Targets related to lung cancer were searched for in the GEO database (accession number GSE136043). The volcanic and thermal maps of differential expression genes were produced using the software R. Then, the target genes were analyzed by GO and KEGG analysis using the software R. This also utilized the AutoDock tool to study the molecular docking of the active component structures downloaded from the PubChem database and the key target structures downloaded from the PDB database, and the docking results were visualized using the software PyMol. RESULTS The results of molecular docking show that wogonin, Mono-O-methylwightin, Deoxycamptothecine, andrographidine F_qt, Quercetin tetramethyl (3',4',5,7) ether, 14-deoxyandrographolide, andrographolide-19-β-D-glucoside_qt and 14-deoxy-11-oxo-andrographolide were potential active components, while AKT1, MAPK14, RELA and NCOA1 were key targets. CONCLUSION This study showed the main candidate components, targets, and pathways involved in the action of Andrographis paniculata against lung cancer.
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Affiliation(s)
- Jiaxin Li
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Xiaonan Liu
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiaxin Li
- Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Dongwei Han
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Yu Li
- Department of Oncology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Pengling Ge
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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Kawaguchi K, Ito A, Kaneda S, Kawaguchi T, Shimamoto A, Takao M. Two different methods of bronchial dissection and coverage in robotic bilobectomy for advanced lung cancer. Asian J Endosc Surg 2023; 16:147-151. [PMID: 35781102 DOI: 10.1111/ases.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Due to its many technical advantages, the scope of robot-assisted thoracic surgery (RATS) is expanding to include extended pulmonary resection. Among such procedures, right bilobectomy is one with a high risk of inducing development of a bronchial stump fistula. MATERIALS AND SURGICAL TECHNIQUE The pericardial fat pad case involved a 71-year-old man with a 31-mm adenocarcinoma in the right lung that had progressed to the intermediate bronchus. During lower bilobectomy, to confirm the tumor margin, an L-shaped stapler was used with stapling only at the oral side, and the bronchus was cut using a scalpel blade grasped with robot forceps. After confirming a negative stump, the pericardial fat was collected at the pedicle and sewn onto the stump. The intercostal muscle (ICM) flap case involved a 61-year-old man with a 16-mm nodule shadow in the lower lobe of his lung and swollen #11i and 7 lymph nodes. Intraoperatively, the #7 lymph node was diagnosed as non-small-cell lung cancer by frozen sections, and lower bilobectomy was performed. The bronchus was divided using a stapler with a green cartridge, and the ICM flap was harvested by changing the direction of the camera to a look-up view and positioning the camera at the 5th intercostal site. His numeric rating score (NRS) at 30 and 90 days post-surgery was 2 and 0, respectively. DISCUSSION Our RATS technique was useful for harvesting the ICM flap. More cases should be accumulated to extend the surgical indication for RATS.
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Affiliation(s)
- Koji Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shinji Kaneda
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Teruhisa Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Endogenous stimuli-responsive nanoparticles for cancer therapy: From bench to bedside. Pharmacol Res 2022; 186:106522. [DOI: 10.1016/j.phrs.2022.106522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
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Perioperative and Oncological Outcomes of Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy for Patients with N1-Metastatic Non-Small Cell Lung Cancer: A Propensity Score-Matched Study. Cancers (Basel) 2022; 14:cancers14215249. [PMID: 36358668 PMCID: PMC9655678 DOI: 10.3390/cancers14215249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Despite the fact that robotic-assisted thoracoscopic lobectomy (RATL) has been prevalently applied for early stage non-small cell lung cancer (NSCLC), its superiorities are still to be fully revealed for patients with metastatic N1 lymph nodes (LNs). We aim to evaluate the advantages of RATL for N1 NSCLC. (2) Methods: This retrospective study identified consecutive pathological N1 NSCLC patients undergoing RATL, video-assisted thoracoscopic lobectomy (VATL), or open lobectomy (OL) in Shanghai Chest Hospital between 2014 and 2020. Further, perioperative and oncological outcomes were investigated. (3) Results: A total of 855 cases (70 RATL, 435 VATL, and 350 OL) were included. Propensity score matching resulted in 70, 140, and 140 cases in the RATL, VATL, and OL groups, respectively. RATL led to (1) the shortest surgical time (p = 0.005) and lowest intraoperative blood loss (p < 0.001); (2) the shortest ICU (p < 0.001) and postsurgical hospital (p < 0.001) stays as well as chest tube duration (p < 0.001); and (3) the lowest morbidities of postsurgical complications (p = 0.016). Moreover, RATL dissected more N1 (p = 0.027), more N1 + N2 (p = 0.027) LNs, and led to a higher upstaging incidence rate (p < 0.050) than VATL. Finally, RATL achieved a comparable 5-year disease-free and overall survival in relation to VATL and OL. (4) Conclusions: RATL led to the most optimal perioperative outcomes among the three surgical approaches and showed superiority in assessing N1 and total LNs over VATL, though it did achieve comparable oncological outcomes in relation to VATL and OL for N1 NSCLC patients.
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Pan H, Gu Z, Tian Y, Jiang L, Zhu H, Ning J, Huang J, Luo Q. Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older. Front Oncol 2022; 12:1009298. [PMID: 36185241 PMCID: PMC9525021 DOI: 10.3389/fonc.2022.1009298] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Although robot-assisted thoracoscopic surgery (RATS) has been widely applied in treating non-small cell lung cancer (NSCLC), its advantages remain unclear for very old patients. The present study compared the perioperative outcomes and survival profiles among RATS, video-assisted thoracoscopic surgery (VATS), and open lobectomy (OL), aiming to access the superiority of RATS for NSCLC patients aged ≥75 years. Methods Pathological IA-IIIB NSCLC patients aged ≥75 years who underwent RATS, VATS, or OL between June 2015 and June 2021 in Shanghai Chest Hospital were included. Propensity score matching (PSM, 1:1:1 RATS versus VATS versus OL) was based on 10 key prognostic factors. The primary endpoints were perioperative outcomes, and the secondary endpoints were disease-free (DFS), overall (OS), and cancer-specific survival (CS). Results A total of 504 cases (126 RATS, 200 VATS, and 178 OL) were enrolled, and PSM led to 97 cases in each group. The results showed that RATS led to: 1) the best surgical-related outcomes including the shortest operation duration (p <0.001) and the least blood loss (p <0.001); 2) the fastest postoperative recoveries including the shortest ICU stay (p = 0.004), chest tube drainage duration (p <0.001), and postoperative stay (p <0.001), and the most overall costs (p <0.001); 3) the lowest incidence of postoperative complications (p = 0.002), especially pneumonia (p <0.001). There was no difference in the resection margins, reoperation rates, intraoperative blood transfusion, and volume of chest tube drainage among the three groups. Moreover, RATS assessed more N1 (p = 0.009) and total (p = 0.007) lymph nodes (LNs) than VATS, while the three surgical approaches dissected similar numbers of N1, N2, and total LN stations and led to a comparable incidence of postoperative nodal upstaging. Finally, the three groups possessed comparable DFS, OS, and CS rates. Further subgroup analysis found no difference in DFS or OS among the three groups, and multivariable analysis showed that the surgical approach was not independently correlated with survival profiles. Conclusion RATS possessed the superiority in achieving better perioperative outcomes over VATS and OL in very old NSCLC patients, though the three surgical approaches achieved comparable survival outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Jia Huang
- *Correspondence: Jia Huang, ; Qingquan Luo,
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10
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Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation. J Craniofac Surg 2022; 33:2011-2018. [PMID: 35864585 PMCID: PMC9518970 DOI: 10.1097/scs.0000000000008684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons.
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11
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Zhang F, Xu L, Lu H, Ma A, Wang G. Short-Term Surgical Outcomes for Lobectomy Between Robot-Assisted Thoracic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery. Front Oncol 2022; 12:914059. [PMID: 35912191 PMCID: PMC9326123 DOI: 10.3389/fonc.2022.914059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the short-term outcomes of uniportal video–assisted thoracoscopic surgery (UVATS) and Da Vinci robot–assisted thoracoscopic surgery (RATS) in lobectomy and lymph node (LN) dissection. Methods The two groups of patients with primary non-small cell lung cancer (NSCLC; RATS group, UVATS group) were matched by the propensity score to compare LN dissection and recent clinical outcomes. The results were analyzed by univariate analysis. From November 2020 to November 2021, 412 NSCLC patients (54 RATS and 358 UVATS) from a single institution of the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. Age, sex, lung lobe, surgical resection scope, solid nodules, and core tumor ratios were matched according to different surgical methods. Results From November 2020 to November 2021, 412 patients with NSCLC (54 RATS, 358 UVATS) from the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. According to our matching results, LN dissection was more thorough in the RATS group. Conclusion RATS has potential advantages over UVATS in radical lung cancer surgery.
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Affiliation(s)
- Fan Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lin Xu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongda Lu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Anqun Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gongchao Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
- *Correspondence: Gongchao Wang,
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Nie Y, Dai Z, Fozia, Zhao G, Jiang J, Xu X, Ying M, Wang Y, Hu Z, Xu H. Comparative Studies on DNA-Binding Mechanisms between Enantiomers of a Polypyridyl Ruthenium(II) Complex. J Phys Chem B 2022; 126:4787-4798. [PMID: 35731588 DOI: 10.1021/acs.jpcb.2c02104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A pair of ruthenium(II) complex enantiomers, Δ- and Λ-[Ru(bpy)2MBIP]2+ (bpy = 2,2'-bipyridine, MBIP = 2-(3-bromophenyl)imidazo[5,6-f]phenanthroline), were designed, synthesized, and characterized. Comparative studies between the enantiomers on their binding behaviors to calf thymus DNA (CT-DNA) were conducted using UV-visible, fluorescence, and circular dichroism spectroscopies, viscosity measurements, isothermal titration calorimetry, a photocleavage experiment, and molecular simulation. The experimental results indicated that both the enantiomers spontaneously bound to CT-DNA through intercalation stabilized by the van der Waals force or the hydrogen bond and driven by enthalpy and that Δ-[Ru(bpy)2MBIP]2+ intercalated into DNA more deeply than Λ-[Ru(bpy)2MBIP]2+ did and exhibited a better DNA photocleavage ability. Molecular simulation further indicated that Δ-[Ru(bpy)2MBIP]2+ more preferentially intercalated between the base pairs of CT-DNA to the major groove, and Λ-[Ru(bpy)2MBIP]2+ more favorably intercalated to the minor groove. These research findings should be very helpful to the understanding of the stereoselectivity mechanism of DNA-bindings of metal complexes, and be useful for the design of novel metal-complex-based antitumor drugs with higher efficacy and lower toxicity.
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Affiliation(s)
- Yanhong Nie
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Zhongming Dai
- Shenzhen University General Hospital, Shenzhen 518060, P. R. China
| | - Fozia
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China.,China Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, P. R. China
| | - Guangyao Zhao
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Jianrong Jiang
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Xu Xu
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Ming Ying
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Yu Wang
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
| | - Zhangli Hu
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China.,Southern Marine Science and Engineering Guangdong Laboratory (Guangzhou), Guangzhou 511458, P. R. China
| | - Hong Xu
- Guangdong Technology Research Center for Marine Algal Bioengineering, Guangdong Provincial Key Laboratory for Plant Epigenetics, Shenzhen Engineering Laboratory for Marine Algal Biotechnology, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen Key Laboratory of Microbial Genetic Engineering, Longhua Innovation Institute for Biotechnology, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518060, P. R. China
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Nechay TV, Panin SI, Sazhin AV, Bykov AV, Kuznetsov AA, Tyagunov AE, Melnikov-Makarchuk KY. [Comparison of robot-assisted and conventional endoscopic surgeries in the Russian Federation. (A systematic review and meta-analysis)]. Khirurgiia (Mosk) 2022:88-101. [PMID: 35658141 DOI: 10.17116/hirurgia202206188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation. MATERIAL AND METHODS Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis. RESULTS We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors. CONCLUSION Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.
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Affiliation(s)
- T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S I Panin
- Volgograd State Medical University, Volgograd, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Bykov
- Volgograd State Medical University, Volgograd, Russia
| | - A A Kuznetsov
- Volgograd State Medical University, Volgograd, Russia
| | - A E Tyagunov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Shidei H, Mitsuboshi S, Yamamoto T, Kanzaki M. Single-incision port robot-assisted surgery for thymic carcinoid tumor resection. J Cardiothorac Surg 2022; 17:90. [PMID: 35505364 PMCID: PMC9066919 DOI: 10.1186/s13019-022-01847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple endocrine neoplasia (MEN) is divided into MEN type 1 (MEN-1) and MEN type 2 (MEN-2). MEN-1 may be associated with thymic carcinoid tumors. We present a case of the surgical removal of a thymic carcinoid associated with MEN-1 via a single-incision port RATS. CASE PRESENTATION A 39-year-old male patient with multiple endocrine neoplasia type 1 (MEN-1) who had an anterior mediastinal mass was referred to our hospital. The patient had undergone total parathyroidectomy and auto-transplantation of a partial parathyroid for hyperparathyroidism 6 years ago. Chest computed tomography revealed an isolated anterior mediastinal mass on the thymic gland with a maximum diameter measuring 22 mm. Thymic carcinoid tumor is classified as MEN-1 and has a poor prognosis, so we decided to remove the tumor. Single-incision port RATS was performed, and thymic carcinoid was confirmed in pathology. CONCLUSIONS This report demonstrates that thymic carcinoid tumor removal is feasible and easy to perform via single-incision port RATS.
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Affiliation(s)
- Hiroaki Shidei
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shota Mitsuboshi
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Tomoko Yamamoto
- Department of Surgical Pathology, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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15
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Huang J, Tian Y, Li C, Shen Y, Li H, Lv F, Lin H, Lu P, Lin J, Lau C, Terra RM, Jiang L, Luo Q. Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial. Transl Lung Cancer Res 2022; 10:4281-4292. [PMID: 35004256 PMCID: PMC8674609 DOI: 10.21037/tlcr-21-898] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 12/25/2022]
Abstract
Background Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients. Methods Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group. Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients. Results Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups. Conclusions RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients. Trial registration Chinese Clinical Trial Registry ChiCTR-INR-17012777.
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Affiliation(s)
- Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Tian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chongwu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yaofeng Shen
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanzhen Lv
- Department of Thoracic Surgery, The Affiliated Huadong Hospital of Fudan University, Shanghai, China
| | - Hao Lin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Peiji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jules Lin
- Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ricardo Mingarini Terra
- Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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16
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Koen A, Maeda H, Nagashima Y, Kanzaki M. Surgical resection of a rapidly growing pulmonary spindle cell carcinoma by robot-assisted thoracoscopic surgery: a case report. Surg Case Rep 2021; 7:222. [PMID: 34632553 PMCID: PMC8502716 DOI: 10.1186/s40792-021-01305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pulmonary spindle cell carcinoma (PSCC) is an extremely rare tumor that is highly malignant and fast-growing. As chemotherapy and radiation therapy are ineffective, early surgical resection is effective for PSCC. CASE PRESENTATION A 70-year-old woman with rheumatoid arthritis was referred to our hospital with an abnormal shadow. Chest computed tomography revealed a 33-mm-wide lobular mass in the right upper lobe. She was diagnosed with non-small cell lung cancer by bronchoscopic smear cytology. Although staging evaluation indicated stage IIIB (T3N2M0) disease, she required continued administration of immunosuppressants and prednisolone for rheumatoid arthritis. Therefore, robot-assisted thoracoscopic surgery (RATS) right upper lobectomy followed by lymph node dissection was performed without preoperative chemotherapy and radiotherapy. Pathological findings revealed PSCC. CONCLUSIONS We report a very rare case of pulmonary spindle cell carcinoma, successfully resected with RATS.
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Affiliation(s)
- Akihiro Koen
- Department of Thoracic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
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17
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Kanzaki M, Mitsuboshi S, Koen A, Isaka T, Matsumoto T, Aoshima H, Maeda H, Shidei H. Effects of robot- and video-assisted thoracoscopic lobectomy experiences on the learning curve of lobectomy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2021; 29:527-535. [PMID: 35096451 PMCID: PMC8762915 DOI: 10.5606/tgkdc.dergisi.2021.21314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/18/2021] [Indexed: 04/30/2023]
Abstract
BACKGROUND This study aims to investigate the effects of robot- and videoassisted thoracoscopic lobectomy on the learning curve of lobectomy. METHODS Between September 2013 and February 2020, the first 68 consecutive patients (28 males, 40 females; median age: 71 years; range, 33 to 86 years) who were operated for lung malignancies and scheduled for robot-assisted thoracoscopic lobectomy were retrospectively analyzed. The characteristics of the patients and operative data were analyzed, and the operation times of the first 51 cases of video-assisted thoracoscopic lobectomy were compared with those of robot-assisted thoracoscopic lobectomy performed by a single surgeon. RESULTS Of the patients, 62 had primary lung cancer and six had metastatic lung tumors. The majority of primary lung cancer patients (87.1%) had an adenocarcinoma. The most common clinical stage was IA1 (30.9%). There was no emergent conversion to thoracotomy in any of the patients. The median operation time was 223.5 min, and console time was 151 min. The most common complication was an air leak. All patients were alive. Compared to video-assisted thoracoscopic lobectomy, the median operation time was significantly longer in the robot-assisted thoracoscopic lobectomy group (p=0.0002). Similar to the operation time learning curve of the video-assisted thoracoscopic surgery group, the operation time learning curve of the robotassisted thoracoscopic surgery group increased from the first to ninth case (Phase 1), plateaued from the 10th t o 14th c ase ( Phase 2 ), and decreased from the 15th case (Phase 3). There was a statistically significant decrease in the operation time between Phase 1 and Phase 3 (p=0.0063). CONCLUSION The results of robot-assisted thoracoscopic lobectomy by a single surgeon show that this surgery has a longer operation time, but the perioperative outcomes are satisfactory. The learning curve of this surgery may be gradual for experienced video-assisted thoracoscopic surgeons.
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Affiliation(s)
- Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Akihiro Koen
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takako Matsumoto
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroe Aoshima
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroaki Shidei
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Mitsuboshi S, Shidei H, Koen A, Maeda H, Aoshima H, Isaka T, Kanzaki M. A pulmonary ligament approach for portal robotic segmentectomy of the lateral and posterior basal segments: a case report. J Med Case Rep 2021; 15:196. [PMID: 33894773 PMCID: PMC8070323 DOI: 10.1186/s13256-021-02789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Thoracoscopic segmentectomy of the lateral and posterior basal segments is extremely technically challenging. Appropriate segmentectomy requires exposure and recognition of the branches of the bronchi and pulmonary vessels deep in the lung parenchyma. Although various approaches for these segmentectomies have been reported, the use of a pulmonary ligament approach is rational because it does not require any interlobar separation. Here, we report a successful case of portal robotic segmentectomy of the lateral and posterior basal segments through the pulmonary ligament approach. Case presentation A 60-year-old Japanese man with a history of low anterior resection for rectal cancer was referred to our department because of a lung nodule. His chest computed tomography revealed a 15-mm tumor in the left posterior basal bronchus. Robotic left S9–10 segmentectomy through the pulmonary ligament was performed with five-port incisions. Conclusions An extremely technically challenging thoracoscopic segmentectomy of the lateral and posterior basal segments was performed through the pulmonary ligament using a robotic surgical system. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-02789-3.
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Affiliation(s)
- Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroaki Shidei
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akihiro Koen
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroe Aoshima
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Shidei H, Mitsuboshi S, Akihiro K, Aoshima H, Isaka T, Kanzaki M. Robot-assisted thoracoscopic surgery using a narrow-profile vascular stapler through an 8-mm robotic port. J Surg Case Rep 2021; 2021:rjab157. [PMID: 33927881 PMCID: PMC8068473 DOI: 10.1093/jscr/rjab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/03/2021] [Indexed: 11/12/2022] Open
Abstract
The number of robot-assisted thoracoscopic surgery (RATS) procedures performed for thoracic disease has been increasing. Recently, a narrow-profile vascular stapler (Signia small-diameter reload, Covidien Japan, Tokyo, Japan) has been developed to provide superior access and precise staple placement in video-assisted thoracoscopic surgery (VATS) procedures. A 70-year-old man who was an exsmoker visited our hospital with a complaint of coughing. Chest computed tomography revealed a tumor with a cavity, ~55 mm in diameter, in the right-middle lobe. A 4-arm RATS right-middle lobectomy was performed with a 4-cm utility thoracotomy with da Vinci Xi (Intuitive Surgical, Sunnyvale, CA, USA). The pulmonary vessels were divided using a narrow-profile vascular stapler through an 8-mm port. No complications occurred in the postoperative course. With a narrow-profile vascular stapler, portal RATS can be performed after VATS lung biopsy using 8-mm ports.
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Affiliation(s)
- Hiroaki Shidei
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Koen Akihiro
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroe Aoshima
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Esendagli D, Shah U, Batihan G, Magouliotis D, Meloni F, Vos R, Elia S, Hellemons M. ERS International Congress 2020: highlights from the Thoracic Surgery and Transplantation Assembly. ERJ Open Res 2021; 7:00743-2020. [PMID: 33748258 PMCID: PMC7957292 DOI: 10.1183/23120541.00743-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
The Thoracic Surgery and Lung Transplantation Assembly of the European Respiratory Society is delighted to present the highlights from the 2020 Virtual International Congress. We have selected four sessions that discussed recent advances in a wide range of topics. From the use of robotic surgery in thoracic surgery and extracorporeal life support as a bridge to lung transplantation, to lung transplantation in the era of new drugs. The sessions are summarised by early career members in close collaboration with the assembly leadership. We aim to give the reader an update on the highlights of the conference in the fields of thoracic surgery and lung transplantation. The first “virtual” #ERSCongress was a great success, with very diverse and important sessions on innovation and the state of the art in thoracic surgery and lung transplantation, summarised in this articlehttps://bit.ly/392uwUA
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Affiliation(s)
- Dorina Esendagli
- Chest Diseases Dept, Baskent University Hospital, Ankara, Turkey
| | - Unmil Shah
- Heart and Lung Transplant Institute, KIMS, Telangana and Global Hospital, Mumbai, India
| | - Guntug Batihan
- Dept of Thoracic Surgery, Dr Suat Seren Chest Disease and Chest Surgery Education and Research Center, Izmir, Turkey
| | - Dimitrios Magouliotis
- Dept of Thoracic and Cardiovascular Surgery, University of Thessaly, Larissa, Greece
| | - Federica Meloni
- Dept of Respiratory Diseases, University and IRCCS San Matteo Foundation, Pavia, Italy
| | - Robin Vos
- Dept of Respiratory Diseases, University Hospitals Leuven and Dept CHROMETA, BREATHE, KU Leuven, Leuven, Belgium
| | - Stefano Elia
- Dept of Thoracic Surgery, Tor Vergata University, Rome, Italy
| | - Merel Hellemons
- Dept of Pulmonary Medicine, Division of lung Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
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21
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Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections? Curr Opin Anaesthesiol 2021; 34:199-203. [PMID: 33630772 DOI: 10.1097/aco.0000000000000975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. RECENT FINDINGS Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain. SUMMARY Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.
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Mitsuboshi S, Maeda H, Kanzaki M. Application of pelvic-style docking in robotic surgery for lower-middle mediastinal tumors. Asian Cardiovasc Thorac Ann 2020; 29:440-442. [PMID: 33356380 DOI: 10.1177/0218492320984886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For robotic surgery, in a field of view looking upwards, the target lesion to be operated on should lie between the camera port and the robot. The ports are placed at the bottom of the chest wall. If the tumor is located below the inferior pulmonary vein, it is necessary to devise alternative port placement and robot docking methods. In 4 patients who had lower middle mediastinal tumors, the "Pelvic" setting on the visual pad of the patient cart was used, which allows easy access for lower middle mediastinal manipulation and results in minimal issues with robotic arm collisions.
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Affiliation(s)
- Shota Mitsuboshi
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Gall TM, Pencavel TD, Cunningham D, Nicol D, Jiao LR. Transition from open and laparoscopic to robotic pancreaticoduodenectomy in a UK tertiary referral hepatobiliary and pancreatic centre - Early experience of robotic pancreaticoduodenectomy. HPB (Oxford) 2020; 22:1637-1644. [PMID: 32247586 DOI: 10.1016/j.hpb.2020.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/30/2020] [Accepted: 03/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy is performed using an open technique (OPD) as the gold standard. An increase in those performed laparoscopically (LPD) and robotically (RPD) are now reported. We compared the short-term outcomes of RPD cases with LPD and OPD. METHODS A retrospective review of a prospectively collected database was undertaken of our first consecutive RPD, our first LPD and consecutive OPD cases. Those requiring venous and/or arterial resection were excluded. RESULTS RPD (n = 25) had longer median operating times (461 (IQR 358-564) mins) than LPD (n = 41) (330 (IQR 262.5-397.5) mins) and OPD (n = 37) (330 (IQR 257-403) mins, p < 0.0001). Estimated blood loss and transfusion requirement was less after RPD and LPD compared to OPD (p = 0.012 and p < 0.0001 respectively). No RPD cases required conversion to open operation compared to 24.4% of LPD. Morbidity was comparable with a Clavien Dindo score ≥3 in 20.00%, 24.39% and 18.92% for RPD, LPD and OPD respectively (p = 0.83). Post-operative pancreatic fistula rates were seen in 16.00%, 29.27% and 21.62% of our RPD, LPD and OPD cohorts respectively (p = 0.81). 90-day mortality was seen in 0.97% of the total cohort. Length of hospital stay (LOS) was shorter for RPD compared to both LPD (p = 0.030) and OPD (p = 0.002). CONCLUSION RPD is safe to perform with comparable outcomes to LPD and OPD. Further evidence is provided that a randomised controlled trial for PD techniques is required.
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Affiliation(s)
- Tamara Mh Gall
- HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK
| | - Tim D Pencavel
- HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK
| | - David Cunningham
- Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK
| | - David Nicol
- Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK
| | - Long R Jiao
- HPB Surgical Unit, Dept. of Surgery & Cancer, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK; Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK.
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24
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Clinical application and mechanism of traditional Chinese medicine in treatment of lung cancer. Chin Med J (Engl) 2020; 133:2987-2997. [PMID: 33065603 PMCID: PMC7752681 DOI: 10.1097/cm9.0000000000001141] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is a malignant tumor characterized by a rapid proliferation rate, less survivability, high mortality, and metastatic potential. This review focuses on updated research about the clinical application of traditional Chinese medicine (TCM) as an adjuvant therapy to lung cancer treatment and the mechanisms of TCM effect on lung cancer in vitro and in vivo. We summarized the recent 5 years of different research progress on clinical applications and antitumor mechanisms of TCM in the treatment of lung cancer. As a potent adjuvant therapy, TCM could enhance conventional treatments (chemotherapy, radiation therapy, and epidermal growth factor receptors [EGFRs] tyrosine kinase inhibitors [TKIs]) effects as well as provide synergistic effects, enhance chemotherapy drugs chemosensitivity, reverse drug resistance, reduce adverse reactions and toxicity, relieve patients’ pain and improve quality of life (QOL). After treating with TCM, lung cancer cells will induce apoptosis and/or autophagy, suppress metastasis, impact immune reaction, and therapeutic effect of EGFR-TKIs. Therefore, TCM is a promisingly potent adjuvant therapy in the treatment of lung cancer and its multiple mechanisms are worthy of an in-depth study.
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25
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Valverde A, Abdallah S, Danoussou D, Goasguen N, Jouvin I, Oberlin O, Lupinacci RM. Transitioning From Open to Robotic Liver Resection. Results of 46 Consecutive Procedures Including a Majority of Major Hepatectomies. Surg Innov 2020; 28:309-315. [PMID: 32857664 DOI: 10.1177/1553350620954580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aims. Minimally invasive liver resection is a complex and challenging operation. Although authors have reported robotic liver resection shows improved safety and efficacy compared with open liver resection, robotic major liver resections for malignant liver lesions treatment remain inadequately evaluated. The aims of the present study were to evaluate the feasibility and safety of transitioning from open to robotic liver resection in a nonuniversity hospital. Patients and Methods. From December 2015 to March 2020, 46 patients underwent totally robotic-assisted liver resections out of 446 robotic procedures. Also, we retrospectively reviewed the last 27 open right hepatectomies (ORHs) and compared then with the first 25 anatomic robotic-assisted right hepatectomies (RRHs). Results. Mean operative time, mean blood lost, rate of complications, and mean hospital stay were associated with the complexity of the procedure. The comparison between ORH and RRH showed that intraoperative complications were less frequently observed during ORH whereas RRH showed a trend in favor of less blood loss. ORH had a trend toward smaller surgical margins and higher rate of R1 resections. Recurrence occurred in 31 (59%) patients and was more frequently observed after ORH. However, the mean follow-up was significantly shorter after RRH. Conclusion. Our study demonstrated the technical feasibility and safety of transitioning from open to robotic liver resection (including major hepatectomies) in a nonuniversity setting. Higher costs remain an important drawback for robotic surgery.
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Affiliation(s)
- Alain Valverde
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Solafah Abdallah
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Divya Danoussou
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Nicolas Goasguen
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Ingrid Jouvin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Olivier Oberlin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Renato M Lupinacci
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France.,Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise Paré - APHP, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone Veil, Université de Versailles-Saint-Quentin-en-Yvelines et Université Paris-Saclay, France
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26
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Berzenji L, Yogeswaran K, Van Schil P, Lauwers P, Hendriks JMH. Use of Robotics in Surgical Treatment of Non-small Cell Lung Cancer. Curr Treat Options Oncol 2020; 21:80. [PMID: 32767154 DOI: 10.1007/s11864-020-00778-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OPINION STATEMENT Robotic-assisted videothoracoscopic surgery (R-VATS) has become increasingly popular and widely used since its introduction and is nowadays considered a standard treatment approach in many centres for the treatment of non-small cell lung cancer. R-VATS was initially developed to overcome the drawbacks of VATS by offering surgeons more flexibility and three-dimensional optics during thoracoscopic surgery. The effectiveness of R-VATS lobectomy regarding oncological outcomes, morbidity, mortality, and postoperative quality of life (QoL) has been shown in an increasing number of studies. More recently, these results have also been corroborated for sublobar resections, more specifically for segmentectomy. However, no well-powered, multicentre randomized trials have been performed to demonstrate the superiority of R-VATS compared with open surgery or conventional types of VATS (total VATS, uniportal VATS, etc.). The majority of the evidence currently available is based on non-randomized studies, and many studies report conflicting results when comparing R-VATS and conventional VATS. Moreover, there is a lack of data regarding the cost and the cost-efficiency of robotic surgery compared with VATS and open surgery. Current evidence suggests that R-VATS costs are higher than VATS and that a deficit can only be prevented when up to 150-300 thoracic surgery procedures are performed annually. Finally, robotic-assisted laparoscopic surgery showed better ergonomics and reduced musculoskeletal disorders compared with non-robotic laparoscopic surgery.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Krishan Yogeswaran
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium.
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Mitsuboshi S, Ogihara A, Katagiri S, Maeda H, Aoshima H, Matsumoto T, Isaka T, Kanzaki M. Manipulation of long-shaft stapler in robotic-assisted thoracoscopic surgery lung resection. J Surg Case Rep 2020; 2020:rjaa110. [PMID: 32577205 PMCID: PMC7297556 DOI: 10.1093/jscr/rjaa110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/05/2020] [Indexed: 12/31/2022] Open
Abstract
The number of robotic surgical procedures for thoracic disease is increasing. The automatic linear stapler has become a necessary device in endoscopic surgery. A 67-year-old man with a history of smoking was referred to our hospital for an abnormal finding on chest x-ray. Computer tomography of the chest revealed a ground glass nodule in the right middle lobe. We performed right middle wedge resection through the assistant port using a long-shaft stapler (LSS). Because the nodule was diagnosed as an adenocarcinoma on the intraoperative frozen section, the patient underwent robotic-assisted thoracoscopic surgery (RATS) right middle lobectomy using the da Vinci® Xi system. The pulmonary arteries, veins, right middle bronchus and minor fissure were divided using the LSS through the utility thoracotomy or assistant port. The postoperative course was uncomplicated. This case suggests that the LSS can be used in RATS lung resection for cancer.
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Affiliation(s)
- Shota Mitsuboshi
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Akira Ogihara
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Katagiri
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroe Aoshima
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takako Matsumoto
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Li XK, Cong ZZ, Xu Y, Zhou H, Wu WJ, Wang GM, Qiang Y, Shen Y. Clinical efficacy of robot-assisted thoracoscopic surgery for posterior mediastinal neurogenic tumors. J Thorac Dis 2020; 12:3065-3072. [PMID: 32642229 PMCID: PMC7330773 DOI: 10.21037/jtd-20-286] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Robot-assisted thoracic surgery (RATS) has an increasing usage throughout the world. This retrospective cohort study aimed to objectively compare the surgical results between video-assisted thoracic surgery (VATS) and RATS in posterior mediastinal neurogenic tumors (PMNT). Methods We retrospectively reviewed the clinical data of 130 patients diagnosed with posterior mediastinal neurogenic tumor between 2015 and 2018. Magnetic resonance imaging (MRI) or enhanced computed tomography scan (CT-scan) was used to locate the tumor and investigate the Adamkiewicz’s artery preoperatively. The individual surgical approach was determined by both tumor size and patient’s willings. Results The surgical time in RATS (43.2±12.6 min) was tended to be less than that in VATS (47.4±11.9 min) (P=0.054). Meanwhile, the estimated blood loss in RATS group (85.8±22.6 mL) was significantly less than that in VATS group (95.3±28.4 mL) (P=0.040). However, the duration of chest tube (days) and volume of drainage (mL) had no significant difference between two groups (P=0.12 and P=0.68, respectively). The postoperative hospital stay (days) of patients in RATS group (2.2±0.4 days) was significantly shorter than that in VATS group (2.4±0.6 days) (P=0.031). There were no significant differences between two groups in the incidence of the postoperative complications and adverse reactions. Conclusions RATS has the superiorities in terms of surgical blood loss and postoperative hospital stay over VATS for posterior mediastinal neurogenic tumor. In conclusion, RATS could be a feasible and safe way for resecting posterior mediastinal neurogenic tumor.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Hai Zhou
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
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29
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Xie B, Sui T, Qin Y, Miao S, Jiao W. [Comparison of Short-term Outcomes of Lung Segmentectomy by Robotic-assisted and Video-assisted Thoracoscopic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:767-771. [PMID: 31874672 PMCID: PMC6935034 DOI: 10.3779/j.issn.1009-3419.2019.12.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
背景与目的 肺段切除术的开展越来越广泛,在现在的外科技术下,电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)是广泛采用的手术方式,同时机器人辅助胸腔镜手术(robot-assisted thoracic surgery, RATS)也提供了一种精准高效的手术方式,本研究旨在对比两种手术方式在肺段切除术中的短期效果。 方法 回顾性分析2016年1月-2017年4月在青岛大学附属医院胸外科行VATS及RATS肺段切除术的患者临床资料,比较两组患者基线数据及手术时间、术中失血量、淋巴结切除数、术后胸腔引流管带管天数、术后住院天数、术后房颤及肺部感染发生率等。 结果 共166例患者接受肺段切除术,两组均无中转开胸及围手术期死亡病例。其中VATS 85例,RATS 81例,术中淋巴结切除数在RATS组多于VATS组,差异具有统计学意义[(13.07±5.08)个vs(10.81±5.74)个,P=0.010)],两组在手术时间、术中失血量、术后带管时间及住院时间无统计学差异(P > 0.05),术后的房颤、肺漏气(≥6 d)及术后肺炎发生率方面二组差异无统计学意义(P > 0.05)。 结论 相比于VATS,RATS具有相似的安全性及可操作性,淋巴结切除数目较VATS明显为多。
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Affiliation(s)
- Boheng Xie
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Tianyi Sui
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Yi Qin
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Shuncheng Miao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266071, China
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30
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Shidei H, Maeda H, Isaka T, Matsumoto T, Yamamoto T, Nagashima Y, Kanzaki M. Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report. BMC Surg 2020; 20:45. [PMID: 32138719 PMCID: PMC7057551 DOI: 10.1186/s12893-020-00701-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection. Case presentation A 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion. Conclusions RATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.
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Affiliation(s)
- Hiroaki Shidei
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hideyuki Maeda
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Tamami Isaka
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takako Matsumoto
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tomoko Yamamoto
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masato Kanzaki
- Department of Thoracic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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31
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Herrmann D, Oggiano M, Hecker E. [Application of artificial intelligence in thoracic surgery]. Chirurg 2020; 91:206-210. [PMID: 31919545 DOI: 10.1007/s00104-019-01089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The application of artificial intelligence is a relatively new option to enable improved patient treatment in modern medicine and is therefore currently the focus of many research projects. In the clinical practice the application of artificial intelligence so far seems to be confined to the analysis of medical imaging. OBJECTIVE In which form is the use of artificial intelligence possible in routine daily work in thoracic surgery and is already being practiced? MATERIAL AND METHODS A search of the currently available literature was performed. RESULTS Under current conditions artificial intelligence can best be used as part of diagnostics and treatment planning; however, in order to enable a comprehensive use standardization and evaluation of the centralized data collection are necessary. CONCLUSION At the present time promising study results are available but the implementation into the surgical routine has so far been very difficult.
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Affiliation(s)
- D Herrmann
- Thoraxzentrum Ruhrgebiet, Klinik für Thoraxchirurgie, Evangelisches Krankenhaus, Herne, Hordeler Straße 7-9, 44651, Herne, Deutschland
| | - M Oggiano
- Thoraxzentrum Ruhrgebiet, Klinik für Thoraxchirurgie, Evangelisches Krankenhaus, Herne, Hordeler Straße 7-9, 44651, Herne, Deutschland
| | - E Hecker
- Thoraxzentrum Ruhrgebiet, Klinik für Thoraxchirurgie, Evangelisches Krankenhaus, Herne, Hordeler Straße 7-9, 44651, Herne, Deutschland.
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