[Robot-Assisted Minimally Invasive D2 Lymphadenectomy]

Clinical Efficacy of Thoracoscopic Surgery with the da Vinci Surgical System versus Video-Assisted Thoracoscopic Surgery for Lung Cancer

Objective

To assess the clinical efficacy of thoracoscopic surgery with the da Vinci surgical system versus video-assisted thoracoscopic surgery (VATS) for lung cancer.

Methods

From August 2019 to December 2020, 193 patients with lung cancer assessed for eligibility scheduled for surgery in our hospital were recruited and assigned at a ratio of 1 : 1 to receive VATS (control group) or thoracoscopic surgery with the da Vinci surgical system (research group). The primary measurement is the clinical efficacy of the two surgical modalities.

Results

The baseline features of the research group were comparable with those of the control group (P > 0.05). Besides, the two groups showed similar tumor types, tumor locations, and clinicopathological staging (P > 0.05). Da Vinci surgical system-assisted thoracoscopic surgery had short operative time, less intraoperative blood loss, better lymph node dissection, and lower intraoperative conversion rates compared to VATS. Compared with the control group, the research group had significantly higher postoperative forced expiratory volume in one second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), the functional assessment of cancer therapy-general module (FACT-G) of the FACT-lung (FACT-L) Chinese version V4.0, lung cancer-specific module scores, and total scores (P < 0.05). The research group showed better postoperative drainage volume, shorter intubation duration, and length of hospital stay and a lower incidence of complications versus the control group (P < 0.05). The da Vinci surgical system reduced the probability of intraoperative mistakes and better ensured a safe and satisfactory surgery.

Conclusion

The thoracoscopic surgery with the da Vinci surgical system better reduces intraoperative and postoperative bleeding, shortens drainage and intubation duration, enhances the lung function and survival quality of patients, and lowers the risk of surgical mistakes to ensure surgical safety versus VATS.

Robotisch assistierte totale Gastrektomie mit D2-Lymphadenektomie und intrakorporaler Rekonstruktion

Die robotisch assistierte totale Gastrektomie beim Magenkarzinom ist eine anspruchsvolle Operation, die in Asien, aber zunehmend auch in Europa in spezialisierten Zentren durchgeführt wird. Die minimalinvasive Resektion, aber vor allem die Lymphadenektomie und minimalinvasive intrakorporale Ösophagojejunostomie sind technisch anspruchsvolle operative Schritte, deren Technik international in verschiedenen Variationen durchgeführt wird. In dem vorgestellten Video zeigen wir die robotisch assistierte minimalinvasive Technik der totalen Gastrektomie mit D2-Lymphadenektomie und intrakorporaler Rekonstruktion mittels Seit-zu-Seit-Ösophagojejunostomie in linearer Staplertechnik. Die DaVinci-Xi-assistierte Operationstechnik wird detailliert beschrieben und in dem zugehörigen Video demonstriert.