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Lee JH, Park TH, Kim HK. Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00206-X. [PMID: 38678475 DOI: 10.1016/j.jtcvs.2024.03.005] [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: 11/02/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE This study aimed to report the initial experiences of 115 patients who underwent robotic thoracic surgery using the da Vinci single-port robotic surgical system (Intuitive Surgical). METHODS Robotic thoracic surgery using the da Vinci single-port robotic surgical system was performed on 115 patients between November 2020 and June 2023. Patient characteristics, intraoperative outcomes, and postoperative outcomes were analyzed retrospectively. RESULTS The type of surgeries included thymectomy, mediastinal mass excision, anatomical pulmonary resection (including lobectomy and segmentectomy), esophagectomy, and enucleation of esophageal submucosal tumors in 41, 13, 54, 5, and 2 patients, respectively. The mean total operative time and chest tube duration for different procedures were as follows: thymectomy, 152.9. ± 6.7 minutes and 1.2 ± 0.5 days; mediastinal mass excision, 93.3 ± 26.5 minutes and 1.0 ± 0 days; anatomical pulmonary resection, 187.2 ± 55.8 minutes and 2.5 ± 1.5 days; esophagectomy, 485 ± 111.9 minutes and 12 ± 4.6 days; and enucleation of esophageal submucosal tumors, 170 ± 30 minutes and 5.5 ± 0.5 days, respectively. Conversion to a thoracotomy or sternotomy was not required. Conversion to video-assisted thoracic surgery occurred in 1 patient, and an additional port was applied in 2 patients. Two patients experienced postoperative complications greater than grade IIIa. CONCLUSIONS Robotic thoracic surgery using the da Vinci single-port robotic surgical system is feasible and safe in various fields of thoracic surgery, including complex procedures such as anatomical pulmonary resection and esophagectomy. More complex thoracic surgeries can be performed with the continuous advancement and innovation of instruments in robotic systems.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Winter H, Eichhorn M, Eichhorn F, Grott M. [Modern individualized diagnostics and treatment of non-small cell lung cancer]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:280-287. [PMID: 38376521 DOI: 10.1007/s00104-024-02037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Approximately one half of patients with non-small cell lung cancer (NSCLC) are diagnosed at resectable tumor stages (I-IIIA), which can potentially be curatively treated. In the early tumor stages (tumor diameter ≤2 cm) sublobar resection (segmentectomy or atypical wedge resection) leads to a 5‑year long-term survival comparable to lobectomy. The use of immunotherapy, especially within the framework of neoadjuvant treatment, is anticipated to change the surgical treatment of NSCLC in the future. With the introduction of lung cancer screening for certain risk groups in Germany planned for 2024, lung tumors can be expected to be diagnosed at earlier stages and more frequently curatively treated. This article provides an overview of the potential impact of lung cancer screening, modern minimally invasive surgical techniques and neoadjuvant treatment concepts for the surgical treatment of NSCLC.
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Affiliation(s)
- Hauke Winter
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland.
| | - Martin Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Florian Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Matthias Grott
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
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Lee JH, Hong JI, Kim HK. Single-port robotic subcostal major pulmonary resection using the single-port robotic system. World J Surg 2024; 48:713-722. [PMID: 38501549 DOI: 10.1002/wjs.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND The da Vinci single-port system (SPS) (Intuitive Surgical, Sunnyvale, CA, USA) was designed for single-port (SP) surgery. Although we have reported our clinical outcomes using the SPS for a simple procedure in general thoracic surgery, major pulmonary resection had been performed only in cadaveric experiments to date. This study evaluated the feasibility of SP subcostal robotic major pulmonary resection using the SPS. Here, we present our initial clinical experience of SP subcostal robotic major pulmonary resection at our institution. METHODS Twenty-five patients with lung cancer underwent SP major subcostal pulmonary resection using the SPS between March and November 2022. Patient characteristics, intraoperative and perioperative outcomes were assessed. Questionnaires were used to evaluate patient satisfaction with the cosmetic results and quality of life through face-to-face or telephone interviews on postoperative day 30. RESULTS All patients underwent major pulmonary resection with complete radical resection (R0). Nineteen patients underwent lobectomy, whereas six patients underwent segmentectomy. The mean docking time and total operative time were 4.16 ± 1.19 min (range, 2.3-7.8 min) and 197.6 ± 55.33 min (range, 130-313 min), respectively. No patients underwent conversion to open thoracotomy. One patient required an additional assistant port due to severe pleural adhesions. CONCLUSIONS SP subcostal robotic major pulmonary resection using the SPS is feasible and safe. With the continuous development of robotic technology and surgical techniques, we believe that more complex general thoracic surgeries will be performed in the future using SPS.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeong In Hong
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
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E H, Yang C, Zhang L, Xia L, Xu L, Song N, Hu X, Zhu Y, Chen C, Zhao D. Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience. Updates Surg 2023:10.1007/s13304-023-01702-5. [PMID: 38060172 DOI: 10.1007/s13304-023-01702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The advent of robot-assisted thoracoscopic surgery (RATS) has completely revolutionized the modality of thymectomy, which could reportedly achieve equivalent efficacy compared with a minimally invasive approach. This study was conducted to further compare the perioperative outcomes between these two modalities. METHODS A retrospective single-center study that included patients receiving either a robotic or video-assisted thoracoscopic (VAT) thymectomy between February 2021 and January 2023 was conducted. All the patients were pathologically confirmed with thymic epithelial tumors. Clinical and pathological characteristics and perioperative outcomes were collected and compared between these two cohorts. RESULTS A total of 190 patients were included in this study, with 61 (32.1%) and 129 (67.9%) receiving robotic and video-assisted thymectomy, respectively. The clinicopathological characteristics were not significantly different between these 2 groups. The size of the resected specimens in the RATS cohort was larger than the VATS cohort [median (IQR), 13.0 (8.0-16.0) vs. 9.0 (6.7-12.0) cm, p < 0.001], while the procedural duration was longer for the RATS group than its counterpart [median (IQR), 105 (85-143) vs. 85 (69-115) min, p = 0.001]. Moreover, no other significant difference was observed between these two groups. Since more than half of the robotic thymectomy was performed using a subxiphoid approach, a subgroup analysis was further conducted. Similarly, the robotic group through a subxiphoid approach harbored a longer procedural duration, and the size of the specimens obtained was larger than the VATS group [median (IQR), 14.0 (11.0-16.5) vs. 12.5 (8.5-15.0) cm, p = 0.061]. CONCLUSIONS The early clinical efficacy of robotic thymectomy was proven comparable to the established VATS approach, and such a modality might have strength when obtaining larger specimens, which could contribute to improving long-term efficacy. Despite the longer procedural duration recorded in the early stage of conducting robotic thymectomy, further accumulation would help decrease the time.
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Affiliation(s)
- Haoran E
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lang Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China.
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Huang F, Sang H, Liu F, Han R. Dimensional optimisation and an inverse kinematic solution method of a safety-enhanced remote centre of motion manipulator. Int J Med Robot 2023:e2579. [PMID: 37727021 DOI: 10.1002/rcs.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND With the expansion of minimally invasive surgery (MIS) applications in surgery, the remote centre of motion (RCM) manipulator requires a more flexible workspace to meet different operation requirements. Thus, the mechanical structure and motion control of the RCM manipulator play important roles. METHODS A multi-objective genetic algorithm was exploited to maximise the kinematic performance and obtain a compact structure of the RCM manipulator. An inverse kinematic solution method is proposed to meet task accuracy and kinematic singularity avoidance constraints for safety motion control. RESULTS Simulation results demonstrate that there are significant improvements in the reachable workspace inside the abdominal cavity, the flexibility of the workspace, kinematic performance, and compactness of the RCM manipulator. Experiments verify the feasibility of the prototype and the validity of the proposed inverse kinematic solution method. CONCLUSIONS This enhances the adaptability and safety of the RCM manipulator and provides potential prospects for MIS application.
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Affiliation(s)
- Fang Huang
- School of Mechanical Engineering, Tiangong University, Tianjin, China
| | - Hongqiang Sang
- School of Mechanical Engineering, Tiangong University, Tianjin, China
- Tianjin Key Laboratory of Advanced Mechatronic Equipment Technology, Tiangong University, Tianjin, China
| | - Fen Liu
- School of Mechanical Engineering, Tiangong University, Tianjin, China
| | - Rui Han
- School of Mechanical Engineering, Tiangong University, Tianjin, China
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Chendaer N, Jiang N, Hao Y, Zhao Y, Li G, Zhang W, Peng C. A Propensity Score-Matching Analysis: Robotic Thymectomy Through the Subxiphoid Has Advantages Over Video-Assisted Thymectomy Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:859-865. [PMID: 37410501 DOI: 10.1089/lap.2023.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Objective: The purpose of this article is to evaluate the security and effectiveness of subxiphoid and subcostal robot-assisted thoracoscopic thymectomy (S-RATT) and compare it with subxiphoid and subcostal video-assisted thoracoscopic thymectomy (S-VATT) in terms of short-term perioperative results and costs. Methods: A retrospective study was carried out on 62 individuals who had undergone successful complete thymectomy for anterior mediastinal disease using subxiphoid and subcostal arch approaches. Propensity score-matching analysis was utilized between the two groups, and the perioperative outcomes were compared. Results: The S-RATT group exhibited less intraoperative blood loss (20 ± 15.35 versus 69.55 ± 69.54, P < .001), lower levels of C-reactive protein (112.38 ± 68.08 versus 72.58 ± 42.62, P = .027), and lower postoperative pain scores (2.09 ± 1.54 versus 4.27 ± 1.28, P < .001). However, the hospitalization costs of patients in the S-VATT group were found to be lower than those in the S-RATT group (33,802.41 ± 8785.05 versus 49,977.53 ± 20,221.79, P < .001). Conclusions: S-RATT appears to be a viable and secure method for managing anterior mediastinal tumors.
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Affiliation(s)
- Nuerboli Chendaer
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ning Jiang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yingtao Hao
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yunpeng Zhao
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Gen Li
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Weiquan Zhang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chuanliang Peng
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Wu CF, Cheng C, Suen KH, Stein H, Chao YK. A Preclinical Feasibility Study of Single-Port Robotic Subcostal Anatomical Lung Resection and Subxiphoid Thymectomy Using the da Vinci ® SP System. Diagnostics (Basel) 2023; 13:diagnostics13030460. [PMID: 36766565 PMCID: PMC9914746 DOI: 10.3390/diagnostics13030460] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Despite the recent introduction of technologically advanced single-port (SP) robotic systems, their use in the field of thoracic surgery has been rarely explored. Here, we report our preclinical experience concerning SP robotic thoracic surgery using the da Vinci® SP system. The da Vinci® SP system was used to perform subcostal anatomical lung resection and subxiphoid thymectomy in three cadavers. The operative settings that best met the surgeon's requirements for each resection were also determined. Four subcostal anatomical lung resections and two subxiphoid thymectomies were completed. While both procedures did not require additional incisions, the use of an observation port in the intercostal spaces was strongly recommended to safely create subcostal access. Dissection of hilar structures and mediastinal lymph nodes was feasible. However, due to the current unavailability of a robotic stapler, a handheld stapling instrument was required to perform a transection of vital structures. When the stapling process proved to be difficult, the table surgeon temporarily removed a robotic arm to acquire the necessary space to complete the procedure. Our data represent a promising preclinical step in understanding the feasibility of using the da Vinci® SP system to perform an SP subcostal anatomical lung resection and a subxiphoid thymectomy.
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Affiliation(s)
- Ching Feng Wu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333323, Taiwan
| | - Chuan Cheng
- Division of Thoracic Surgery, New Taipei Municipal Tu-Cheng Hospital, New Taipei City 25162, Taiwan
| | - Ka Hei Suen
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA 94086, USA
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA 94086, USA
| | - Yin Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333323, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 2118); Fax: +886-3-3285818
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Zhang H, Wang F, Qiu G, Li Z, Peng L, Wang X, Xie S, Chen LQ, Wang Y. Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy. Surg Endosc 2023; 37:90-100. [PMID: 35836034 DOI: 10.1007/s00464-022-09423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study was to introduce an "eight-step modularized procedure (M-RET)" for trans-subxiphoid robotic extended thymectomy for patients with myasthenia gravis (MG). Its safety and feasibility were further verified in this study. MATERIALS AND METHODS This retrospective study included 87 consecutive MG patients who underwent trans-subxiphoid robotic extended thymectomy at our institution between September 2016 and August 2021. According to different resection models, patients were divided into two groups: traditional trans-subxiphoid robotic extended thymectomy group (T-RET group) and eight-step modularized technique group (M-RET group). Baseline demographic characteristics and operation-related parameters were collected and compared between the two groups. RESULTS There were 41 (47.1%) patients in the M-RET group and 46 (52.9%) patients in the T-RET group. The M-RET group resected a greater amount of mediastinal adipose tissues and required more dissection time (median and interquartile range: 135.0, 125.0 to 164.0 v. 120.0, 105.0 to 153.8, P = 0.006) compared with the T-RET group. There were no statistically significant differences in terms of the intraoperative blood loss, duration of chest drainage, length of hospital stay, and postoperative complications between the two groups. There was no mortality or conversion in each of the two groups and all patients recovered well upon discharge. CONCLUSION The eight-step modularized technique of trans-subxiphoid robotic extended thymectomy was verified to be a safe, effective, radical procedure, which offers unique superiority over ectopic thymic tissue resection.
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Affiliation(s)
- Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Guanghao Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Zhiyang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Lei Peng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Xuyang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Shenglong Xie
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.,Department of Thoracic Surgery, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People's Hospital, Chengdu, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Li B, Niu L, Gu C, He K, Wu R, Pan Z, Chen S. Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma. Front Surg 2022; 9:984043. [PMID: 36338633 PMCID: PMC9632990 DOI: 10.3389/fsurg.2022.984043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the clinical efficacy of the subxiphoid approach for early anterior mediastinal thymoma and evaluate its advantages over the lateral intercostal approach. Methods A total of 345 patients with early anterior mediastinal thymoma were retrospectively analyzed from January 2016 to December 2020 in the First Affiliated Hospital of Soochow University. Out of these, 99 patients underwent subxiphoid video-assisted thoracoscopic thymectomy and 246 patients underwent transthoracic video-assisted thoracoscopic thymectomy. We compared the intraoperative conditions (such as operation time and intraoperative blood loss), postoperative conditions [such as postoperative pleural drainage volume, extubation time, postoperative hospital stay, and postoperative visual analogue scale (VAS) pain score], and postoperative complications (such as death, pneumonia, delayed wound healing, cardiac arrhythmia, and phrenic nerve injury) of the two groups and analyzed the clinical advantages of the subxiphoid approach for treating early anterior mediastinal thymoma. Results There was no significant difference between the two groups in terms of general clinical features, operation time, and postoperative complications (P > 0.05).However, there was a significant difference in terms of intraoperative blood loss, postoperative pleural drainage volume, tube extubation time, postoperative hospital stay, postoperative VAS pain score, and postoperative analgesics (a significantly decreased flurbiprofen axetil amount) (P < 0.05). Conclusion Compared with the lateral intercostal thoracic approach, the subxiphoid approach had advantages in terms of intraoperative blood loss, postoperative hospital stay, tube extubation time, postoperative pleural drainage volume, postoperative VAS pain score, and analgesics dosage. It could provide a better view of the bilateral pleural cavities and more thorough thymectomy and superior cosmesis, and it proved to be a safe and feasible minimally invasive surgical method.
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Affiliation(s)
- Bin Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lijuan Niu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenqi Gu
- Department of Imaging, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kaiwen He
- Department of Thoracic Surgery, Changshu No.1 People's Hospital, Changshu, China
| | - Ruizhi Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenfeng Pan
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
| | - Shaomu Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Shaomu Chen Zhenfeng Pan
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Robotic Thymectomy: An Update. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Han KN, Lee JH, Hong JI, Kim HK. Comparison of Two-Port and Three-Port Approaches in Robotic Lobectomy for Non-Small Cell Lung Cancer. World J Surg 2022; 46:2517-2525. [PMID: 35879445 DOI: 10.1007/s00268-022-06660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Robot-assisted lobectomy has been used to treat non-small cell lung cancer and usually uses 3 or 4 ports and 3 or 4 robotic arms. We recently developed a two-port approach for robotic lobectomy using three robotic arms and performed a propensity score-matched analysis to compare the feasibility of the two-port and three-port techniques. METHODS Data on robotic lobectomy for non-small cell lung cancer were retrospectively reviewed. Patients were matched using propensity score based on age, sex, smoking, diabetes, hypertension, forced expiratory volume per 1 s, neoadjuvant chemotherapy, clinical stage, lobe involved, tumor size, and cell types. Overall, 53 and 89 patients who underwent the two-port and three-port approaches, respectively, were matched (1:1 ratio; caliper distance, 0.2). We analyzed the perioperative outcomes and postoperative pain to evaluate the feasibility and safety. RESULTS The matched group included 37 patients each who underwent two-port and three-port robotic lobectomy. The operation time was shorter in the two-port group (P = .01). The number of lymph nodes resected (P = .70), conversion to multiport or thoracotomy (P > .99), morbidity and mortality (P = .31), drain indwelling time (P = .32), and hospital stay (P = .11) were not significantly different between the groups. The postoperative pain was less at 0-3 postoperative days (P < .01) in the two-port group. The total medical cost was not markedly increased after transitioning to the two-port technique. CONCLUSIONS Two-port approach in robotic lobectomy is a safe and feasible alternative approach for treating non-small cell lung cancer.
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Affiliation(s)
- Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jeong In Hong
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Robotic Mediastinal Tumor Resections: Position and Port Placement. J Pers Med 2022; 12:jpm12081195. [PMID: 35893289 PMCID: PMC9330394 DOI: 10.3390/jpm12081195] [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: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the optimal position and port placement during robotic resection for various mediastinal tumors. For anterior mediastinal tumors, total or extended thymectomy is commonly performed in the supine position using the lateral or subxiphoid approach. Although it is unclear which approach is better during robotic thymectomy, technical advantages of subxiphoid approach are beneficial for patients with myasthenia who require extended thymectomy. Partial thymectomy is performed in the supine position using a lateral approach. Superior, middle, and posterior mediastinal tumors are resected in the decubitus position using the lateral approach, whereas dumbbell tumor resection, which requires a posterior approach, can be performed in the prone position. The position and port placement should be chosen depending on the size, location, and aggressiveness of the tumor. In this study, we describe how to choose which of these different robotic approaches can be used based on our experience and previous reports.
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Park SY, Lee JH, Stein H, Heo SY, Kim HK. Initial experience with and surgical outcomes of da Vinci single-port system in general thoracic surgery. J Thorac Dis 2022; 14:1933-1940. [PMID: 35813720 PMCID: PMC9264062 DOI: 10.21037/jtd-21-1739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/18/2022] [Indexed: 11/18/2022]
Abstract
Background The da Vinci single-port system (SPS) (Model SP1098, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been used in genitourinary and general surgical procedures; however, its clinical application in general thoracic surgery has not been attempted. This retrospective study investigated the clinical outcomes of SPS in general thoracic surgery. Methods After approval from the Ministry of Food and Drug Safety in Korea, the surgical details of SPS in simple thoracic surgeries at two independent institutions were collected and retrospectively reviewed. Results Overall, 17 surgeries were performed using SPS without conversion to multiport surgery. The patients included six males, and the overall median age was 52 years (range, 28–83 years). The commonest pathological diagnoses were thymoma (8 cases) and benign cystic lesions (6 cases). The approach for SPS was subxiphoid, subcostal, and intercostal in 11, 4, and 2 cases, respectively. All patients underwent the surgeries without complications. The median operation time and peak pain score were 120 minutes (range, 58–250 minutes) and 3 (range, 2–4). The median duration of in situ chest tube and hospital stay was 1 day (range, 1–2 days) and 3 days (range, 2–7 days), respectively. SPS showed a shorter duration of in situ chest tube and hospital stay than robotic single-site surgeries. Conclusions The application of SPS in the field of general thoracic surgery is feasible and can be successful. Although this study reported preliminary data and the cases were relatively simple, advanced and complex procedures should be attempted with the SPS in the near future.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hubert Stein
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale CA, USA
| | - Seung Young Heo
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale CA, USA
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Gao J, Jin C, Ao YQ, Tang J, Ding JY, Dong JH, Jiang JH. Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study. Gland Surg 2021; 10:3342-3350. [PMID: 35070894 PMCID: PMC8749093 DOI: 10.21037/gs-21-756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/15/2021] [Indexed: 08/31/2023]
Abstract
BACKGROUND Thymectomy has been identified as an effective strategy for patients with myasthenia gravis (MG) and thymic masses. However, the best surgical approach remains a matter of debate. The aim of the present study was to compare the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses. METHODS From August 2013 to April 2018, 68 patients who were diagnosed with MG and thymic masses and underwent video-assisted thoracoscopic thymectomy with a modified subxiphoid (44 patients) or bilateral (24 patients) approach were included in this retrospective study. The surgical and neurological results were analyzed with propensity score matching. RESULTS After propensity score matching, the modified subxiphoid approach in video-assisted thoracoscopic thymectomy resulted in an obviously shorter operative time (P=0.00), drainage duration (P=0.00), less intraoperative blood loss (P=0.00), and shorter postoperative hospital stay (P=0.01). In terms of neurological outcomes, no significant difference was observed in the improvement in MG, with 2-year complete stable remission rates of 21.1% and 26.3% (P=0.68) and 2-year pharmacological remission rates of 31.6% and 26.3% (P=0.60) for the bilateral and subxiphoid approaches, respectively. Additionally, the approaches resulted in similar effects on the magnitudes of decrease in the prednisolone and pyridostigmine doses after 2 years, with average pyridostigmine dose reductions of 72.2% and 71.1% (P=0.78) and average prednisolone reductions of 76.8% and 71.7% (P=0.96) for the bilateral and subxiphoid approaches, respectively. CONCLUSIONS The modified subxiphoid approach was found to be superior to the bilateral approach in video-assisted thoracic surgery thymectomy in terms of the surgical outcomes and yielded similar neurological outcomes. Therefore, the modified subxiphoid approach is recommended as an alternative to the bilateral approach in the treatment of patients with MG and thymic masses.
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Affiliation(s)
- Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Jin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Thoracic Surgery, Changhai hospital, Naval Military Medical University, Shanghai, China
| | - Yong-Qiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Tang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Yong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ji-Hong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia-Hao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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15
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Shen C, Li J, Li J, Che G. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer 2021; 13:151-161. [PMID: 34806328 PMCID: PMC8758429 DOI: 10.1111/1759-7714.14234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background Surgical resection of the thymus is indicated in the presence of primary thymic diseases such as thymoma. Video‐assisted thoracoscopic surgery (VATS) and robot‐assisted thoracic surgery (RATS) offer a minimally invasive approach to thymectomy. However, there is no clear conclusion whether RATS can achieve an equal or even better surgical effect when compared with VATS in treatment of thymoma. We performed this meta‐analysis to explore and compare the outcomes of RATS versus VATS for thymectomy in patients with thymoma. Methods PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were searched for full‐text literature citations. The quality of the articles was evaluated using the Newcastle–Ottawa Scale and the data analyzed using Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis was conducted. Results A total of 11 studies with 1418 patients, of whom 688 patients were in the RATS group and 730 in the VATS group, were involved in the analysis. Compared with VATS, RATS was associated with less blood loss in operation, lower volume of drainage, fewer postoperative pleural drainage days, shorter postoperative hospital stay, and fewer postoperative complications. There was no significant difference in operative time and patients with or without myasthenia gravis between the two groups. Conclusions RATS has more advantages over VATS, indicating that RATS is better than VATS in terms of postoperative recovery. We look forward to more large‐sample, high‐quality randomized controlled studies published in the future.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jialong Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jue Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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Park S. Robot-Assisted Thoracic Surgery Thymectomy. J Chest Surg 2021; 54:319-324. [PMID: 34353974 PMCID: PMC8350461 DOI: 10.5090/jcs.21.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Robotic thymectomy has been adopted recently and has been shown to be safe and feasible in treating thymic tumors and myasthenia gravis. The surgical indications of robotic technology are expanding, with advantages including an excellent surgical view and sophisticated manipulation. Herein, we describe technical aspects, considerations, and outcomes of robotic thymectomy.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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