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Pan JM, Watkins AA, Stock CT, Moffatt-Bruce SD, Servais EL. The Surgical Renaissance: Advancements in Video-Assisted Thoracoscopic Surgery and Robotic-Assisted Thoracic Surgery and Their Impact on Patient Outcomes. Cancers (Basel) 2024; 16:3086. [PMID: 39272946 PMCID: PMC11393871 DOI: 10.3390/cancers16173086] [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: 08/14/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Minimally invasive thoracic surgery has advanced the treatment of lung cancer since its introduction in the 1990s. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) offer the advantage of smaller incisions without compromising patient outcomes. These techniques have been shown to be safe and effective in standard pulmonary resections (lobectomy and sub-lobar resection) and in complex pulmonary resections (sleeve resection and pneumonectomy). Furthermore, several studies show these techniques enhance patient outcomes from early recovery to improved quality of life (QoL) and excellent oncologic results. The rise of RATS has yielded further operative benefits compared to thoracoscopic surgery. The wristed instruments, neutralization of tremor, dexterity, and magnification allow for more precise and delicate dissection of tissues and vessels. This review summarizes of the advancements in minimally invasive thoracic surgery and the positive impact on patient outcomes.
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Affiliation(s)
- Jennifer M Pan
- Division of General Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Ammara A Watkins
- Division of Cardiothoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Cameron T Stock
- Division of Cardiothoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Susan D Moffatt-Bruce
- Division of Cardiothoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Elliot L Servais
- Division of Cardiothoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
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Lee M, Santhirakumaran G, Waller D, Elkhouly A, Dhanji AR, Wilson H, Stamenkovic S. The use of diagnostic complex robotic-assisted segmentectomy in the management of incidental and screen-detected pulmonary nodules. Eur J Cardiothorac Surg 2024; 65:ezae139. [PMID: 38579238 DOI: 10.1093/ejcts/ezae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES Robotic-assisted thoracoscopic surgery (RATS) facilitates complex pulmonary segmentectomy which offers one-stage diagnostic and therapeutic management of small pulmonary nodules. We aimed to explore the potential advantages of a faster, simplified pathway and earlier diagnosis against the disadvantages of unnecessary morbidity in benign cases. METHODS In an observational study, patients with small, solitary pulmonary nodules deemed suspicious of malignancy by a multidisciplinary team were offered surgery without a pre or intraoperative biopsy. We report our initial experience with RATS complex segmentectomy (using >1 parenchymal staple line) to preserve as much functioning lung tissue as possible. RESULTS Over a 4-year period, 245 RATS complex segmentectomies were performed; 140 right: 105 left. A median of 2 (1-4) segments was removed. There was no in-hospital mortality and no requirement for postoperative ventilation. Complications were reported in 63 (25.7%) cases, of which 36 (57.1%) were hospital-acquired pneumonia. A malignant diagnosis was found in 198 (81%) patients and a benign diagnosis in 47 (19%). The malignant diagnoses included: adenocarcinoma in 136, squamous carcinoma in 31 and carcinoid tumour in 15. The most frequent benign diagnosis was granulomatous inflammation in 18 cases. CONCLUSIONS RATS complex segmentectomy offers a precise, safe and effective one-stop therapeutic biopsy in incidental and screen-detected pulmonary nodules.
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Affiliation(s)
- Michelle Lee
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | | | - David Waller
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Ahmed Elkhouly
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Al-Rehan Dhanji
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Henrietta Wilson
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Steven Stamenkovic
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK
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Haruki T, Kubouchi Y, Kidokoro Y, Matsui S, Ohno T, Kojima S, Nakamura H. A comparative study of robot-assisted thoracoscopic surgery and conventional approaches for short-term outcomes of anatomical segmentectomy. Gen Thorac Cardiovasc Surg 2024; 72:338-345. [PMID: 37934374 PMCID: PMC11018688 DOI: 10.1007/s11748-023-01983-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: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Since anatomical segmentectomy requires meticulous dissection of the segmental pulmonary vessels and bronchus, robot-assisted thoracoscopic surgery (RATS) has been widely adopted in recent years. We investigated the usefulness of RATS segmentectomy by comparing perioperative outcomes with conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). We compared perioperative outcomes of segmentectomy between RATS and conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). METHODS This single-institutional retrospective study comprised 231 patients with primary lung cancer who underwent segmentectomy by RATS or conventional approaches between January 2011 and December 2022. Surgical outcomes and postoperative complications were analyzed among patients whose background factors were adjusted by propensity score matching (PSM). RESULTS Before PSM, there were significant differences in age, smoking status, and types of segmentectomy. After PSM, 126 patients (63 patients in each group) were included in this analysis. The RATS group had significantly shorter operative time (154 vs 210 min; p < 0.01), fewer bleeding amounts (10 vs 40 mL; p < 0.01), and shorter duration of chest drainage (2 vs 2 days; p = 0.04) than the conventional-approach group. There was no significant difference in the incidence of all complications; however, the incidence of postoperative pneumonia was significantly lower than in the conventional-approach group (p = 0.02). CONCLUSIONS RATS segmentectomy is proposed to be useful. It was suggested that RATS segmentectomy may be useful with better perioperative results than the conventional approach. Further studies on oncological long-term outcomes and cost-benefit comparisons are needed.
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Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takashi Ohno
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shunsuke Kojima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [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: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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Yang MZ, Tan ZH, Li JB, Xie CL, Sun TY, Long H, Fu JH, Zhang LJ, Lin P, Yang HX. Comparison of Short-Term Outcomes Between Robot-Assisted and Video-Assisted Segmentectomy for Small Pulmonary Nodules: A Propensity Score-Matching Study. Ann Surg Oncol 2023; 30:2757-2764. [PMID: 36774436 DOI: 10.1245/s10434-023-13179-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/02/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Our study aimed to compare the short-term outcomes between robot-assisted segmentectomy (RAS) and video-assisted segmentectomy (VAS) for small pulmonary nodules. METHODS The study included of 299 segmentectomies (132 RAS and 167 VAS procedures) for small pulmonary nodules between June 2018 and November 2021. The patients were divided into two groups: the RAS group and the VAS group. Propensity score-matching (PSM) analysis was performed to minimize bias. A logistic regression model was performed to identify the independent risk factors associated with complications. RESULTS Before PSM, the following clinical variables were not balanced: age (P = 0.004), tumor size (P < 0.001), forced expiratory volume for 1 s (FEV1), and FEV1 percentage (P < 0.001). The patients with RAS had a shorter operative time (P = 0.014), less blood loss, a shorter postoperative hospital stay, less use of strong opioids, less drainage on postoperative day 1, and less postoperative total drainage, but more cost (all P < 0.001). Conversion to open surgery was performed for two patients in the VAS group but none in the RAS group. After PSM, 53 pairs were successfully matched. The data again suggested that the patients with RAS had less blood loss, a shorter postoperative hospital stay, and less use of strong opioids, but more cost (all P < 0.001). The operation time also was shorter in the RAS group, with a borderline statistically significant P value (0.053). CONCLUSIONS In our study, RAS had better short-term outcomes than VAS, indicating a safer and more efficient technique than VAS.
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Affiliation(s)
- Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zi-Hui Tan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ji-Bin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tian-Yu Sun
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lan-Jun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Lampridis S, Maraschi A, Le Reun C, Routledge T, Billè A. Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis. Cancers (Basel) 2023; 15:2391. [PMID: 37190319 PMCID: PMC10136784 DOI: 10.3390/cancers15082391] [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: 03/18/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients' performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; p = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; p < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; p = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS.
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Affiliation(s)
- Savvas Lampridis
- Department of Thoracic Surgery, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Alessandro Maraschi
- Department of Thoracic Surgery, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Corinne Le Reun
- Independent Biostatistician, 97180 Sainte-Anne, Guadeloupe, France
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Andrea Billè
- Department of Thoracic Surgery, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
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Defining the learning curve of robotic portal segmentectomy in small pulmonary lesions: a prospective observational study. J Robot Surg 2023:10.1007/s11701-023-01545-7. [PMID: 36787021 DOI: 10.1007/s11701-023-01545-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
Although robotic segmentectomy has been applied for the treatment of small pulmonary lesions for many years, studies on the learning curve of robotic segmentectomy are quite limited. Thus, we aim to investigate the learning curve of robotic portal segmentectomy with 4 arms (RPS-4) using prospectively collected data in patients with small pulmonary lesions. One hundred consecutive patients with small pulmonary lesions who underwent RPS-4 between June 2018 and April 2021 were included in the study. Da Vinci Si/Xi systems were used to perform RPS-4. The mean operative time, console time, and docking time for the entire cohort were 119.2 ± 41.6, 85.0 ± 39.6, and 6.6 ± 2.8 min, respectively. The learning curve of RPS-4 can be divided into three different phases: 1-37 cases (learning phase), 38-78 cases (plateau phase), and > 78 cases (mastery phase). Moreover, 64 cases were required to ensure acceptable surgical outcomes. The total operative time (P < 0.001), console time (P < 0.001), blood loss (P < 0.001), and chest tube duration (P = 0.014) were reduced as experience increased. In conclusion, the learning curve of RPS-4 could be divided into three phases. 37 cases were required to pass the learning phase, and 78 cases were needed to truly master this technique.
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Mattioni G, Palleschi A, Mendogni P, Tosi D. Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review. J Robot Surg 2022; 17:797-809. [DOI: 10.1007/s11701-022-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
AbstractRobotic-Assisted Thoracic Surgery (RATS) is considered one of the main issues of present thoracic surgery. RATS is a minimally invasive surgical technique allowing enhanced view, accurate and complex movements, and high ergonomics for the surgeon. Despite these advantages, its application in lung procedures has been limited, mainly by its costs. Since now many different approaches have been proposed and the experience in RATS for lungs ranges from wedge resection to pneumonectomy and is mainly related to lung cancer. The present narrative review explores main approaches and outcomes of RATS lobectomy for lung cancer. A non-systematic review of literature was conducted using the PubMed search engine. An overview of lung robotic surgery is given, and main approaches of robotic lobectomy for lung cancer are exposed. Initial experiences of biportal and uniportal RATS are also described. So far, retrospective analysis reported satisfactory robotic operative outcomes, and comparison with VATS might suggest a more accurate lymphadenectomy. Some Authors might even suggest better perioperative outcomes too. From an oncological standpoint, no definitive prospective study has yet been published but several retrospective analyses report oncological outcomes comparable to those of VATS and open surgery. Literature suggests that RATS for lung procedures is safe and effective and should be considered as a valid additional surgical option.
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Abdelghany K, Robinson LA, Tanvetyanon T. Impact of Robotic-Assisted Thoracic Surgery on the Completion of Adjuvant Chemotherapy Following Lung Cancer Resection. Cureus 2022; 14:e30364. [DOI: 10.7759/cureus.30364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
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Mao J, Tang Z, Mi Y, Xu H, Li K, Liang Y, Wang N, Wang L. Robotic and video-assisted lobectomy/segmentectomy for non-small cell lung cancer have similar perioperative outcomes: a systematic review and meta-analysis. Transl Cancer Res 2022; 10:3883-3893. [PMID: 35116688 PMCID: PMC8798077 DOI: 10.21037/tcr-21-646] [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: 04/14/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022]
Abstract
Background At present, the clinical conclusion that robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), which is better for patients with non-small cell lung cancer (NSCLC) is not clear. Therefore, this meta-analysis aimed to compare the perioperative outcomes between RATS and VATS for NSCLC. Methods The Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework was employed to develop the search strategy, and the findings was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched EMbase, The Cochrane Library, PubMed, Web of Science, CNKI, and Wan Fang Data to collect clinical studies about RATS vs. VATS for patients with NSCLC from inception to October 2019. The following outcomes were measured: rate of conversion to thoracotomy, postoperative complications, postoperative hospital mortality, lymph node dissection, hospitalization time, operating time, and postoperative drainage days. Estimation of potential publication bias was conducted by Begg’s test and Egger’s test. The Standardized Mean Difference (SMD) and Odds Ratio (OR) with 95% confidence intervals (CI) were pooled using Stata 15.0 software. Results A total of 18 studies involving 60,349 patients were included. Among them, 8,726 cases were in the RATS group, and 51,623 were in the VATS group. The results of meta-analysis showed that the operation time of RATS group was longer than that of VATS group (SMD=0.532, 95% CI: 0.391–0.674, P=0.000). And the further meta-analysis suggested that the incidence of postoperative complications was lower in patients who underwent RATS after 2015 (OR=0.848, 95% CI: 0.748–0.962, P=0.010). Meanwhile, there was no significant difference between both groups in postoperative hospitalization time (SMD=0.003, 95% CI: −0.104–0.110, P=0.957). In addition, more lymph nodes were retrieved in RATS group than VATS (SMD=0.308, 95% CI: 0.131–0.486, P=0.001). However, the conversion rate, retrieved lymph node station, days to tube removal and in-hospital mortality rate have no significant differences between both groups. Discussion The current meta-analysis indicates that the perioperative outcomes of RATS and VATS for NSCLC are equivalence. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high-quality studies.
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Affiliation(s)
- Junjie Mao
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zilong Tang
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Mi
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haidi Xu
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kuankuan Li
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuxiang Liang
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Na Wang
- Department of Cancer Institute, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Wang
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Durand M, Musleh L, Vatta F, Orofino G, Querciagrossa S, Jugie M, Bustarret O, Delacourt C, Sarnacki S, Blanc T, Khen-Dunlop N. Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology. J Pediatr Surg 2021; 56:1606-1610. [PMID: 33250217 DOI: 10.1016/j.jpedsurg.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/31/2020] [Accepted: 11/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/PURPOSE Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis. METHODS Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014-2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California). RESULTS Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication. CONCLUSIONS Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection - useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.
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Affiliation(s)
- Marion Durand
- Ramsay Générale de Santé, Hôpital Privé d'Antony, Antony, France
| | - Layla Musleh
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France
| | - Fabrizio Vatta
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Department of Pediatric Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Giorgia Orofino
- Département d'Anesthésie Hôpital Necker-Enfants Malades, Paris, France
| | | | - Myriam Jugie
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Bustarret
- Réanimation Chirurgicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Sabine Sarnacki
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Thomas Blanc
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France
| | - Naziha Khen-Dunlop
- Service de Chirurgie Pédiatrique Viscérale, Hôpital Necker-Enfants malades, Paris, France; Université de Paris, Paris, France.
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12
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Geraci TC, Chang SH, Chen S, Ferrari-Light D, Cerfolio RJ. Discharging Patients by Postoperative Day One after Robotic Anatomic Pulmonary Resection. Ann Thorac Surg 2021; 114:234-240. [PMID: 34389302 DOI: 10.1016/j.athoracsur.2021.06.088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our objective is to assess feasibility, safety, and to describe outcomes for patients discharged by postoperative day one (POD1) after robotic segmentectomy and lobectomy. METHODS A retrospective analysis of a prospectively collected database of a quality improvement initiative by a single surgeon. Factors associated with discharge by POD1 were evaluated using a multivariate logistic regression model. RESULTS From January 2018 to July 2020, 253 patients underwent robotic anatomic pulmonary resection of which 134 (53%) discharged by POD1, 67% post segmentectomy and 41% post lobectomy. Discharge by POD1 improved with experience and was achieved in 97% of patients post segmentectomy and 68% post lobectomy in the final quartile. Thirty-one (12%) patients were discharged home with a chest tube, including 7 (2.8%) on POD1. On multivariate analysis, never smokers and segmentectomy were associated with discharge by POD1. Conversely, decreased baseline performance status and perioperative complications were associated with discharge after POD1. There were 10 (4.0%) minor morbidities, 6 (2.4%) major morbidities, and no 30 or 90-day mortalities. There were 4 readmissions (1.6%), of which one (0.4%) was after POD1 discharge. Patient satisfaction remained high throughout the study period. CONCLUSIONS With experience and communication, select patients can be discharged home on POD1 after robotic segmentectomy and lobectomy with excellent outcomes and high satisfaction. Discharge by POD1 was associated with never smokers and segmentectomy, and inversely associated with decreased baseline performance status and perioperative complications.
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Affiliation(s)
- Travis C Geraci
- New York University Langone Health, Department of Cardiothoracic Surgery, New York, NY.
| | - Stephanie H Chang
- New York University Langone Health, Department of Cardiothoracic Surgery, New York, NY
| | - Stacey Chen
- New York University Langone Health, Department of Cardiothoracic Surgery, New York, NY
| | | | - Robert J Cerfolio
- New York University Langone Health, Department of Cardiothoracic Surgery, New York, NY
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Bao F, Dimitrovska NT, Hu S, Chu X, Li W. Safety of early discharge with a chest tube after pulmonary segmentectomy. Eur J Cardiothorac Surg 2021; 58:613-618. [PMID: 32236542 DOI: 10.1093/ejcts/ezaa097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon's experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2-32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Shoujun Hu
- Department of Thoracic Surgery, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Xiao Chu
- Department of Thoracic Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wentao Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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14
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Wu H, Jin R, Yang S, Park BJ, Li H. Long-term and short-term outcomes of robot- versus video-assisted anatomic lung resection in lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:732-740. [PMID: 33367615 DOI: 10.1093/ejcts/ezaa426] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/10/2020] [Accepted: 10/22/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Minimally invasive thoracic surgery has evolved with the introduction of robotic platforms. This study aimed to compare the long-term and short-term outcomes of the robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for anatomic lung resection. METHODS We searched published studies that investigated RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free survival and overall survival) and short-term outcomes (30-day mortality, postoperative complications, conversion rate to open surgery and lymph node upstaging) were extracted. The features were compared and tested as hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval (CI). RESULTS Twenty-five studies with 50 404 patients (7135 for RATS and 43 269 for VATS) were included. The RATS group had a longer disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59-0.97; P = 0.03), and the overall survival showed a similar trend but was not statistically significant (HR: 0.77; 95% CI: 0.57-1.05; P = 0.10). The RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95% CI: 0.38-0.81; P = 0.002). No significant difference was found in postoperative complications (OR: 1.01; 95% CI: 0.87-1.16; P = 0.94), the conversion rate to open surgery (OR: 0.92; 95% CI: 0.56-1.52; P = 0.75) and lymph node upstaging (OR: 0.89; 95% CI: 0.52-1.54; P = 0.68). CONCLUSIONS RATS has comparable short-term outcomes and potential long-term survival benefits for anatomic lung resection compared with VATS.
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Affiliation(s)
- Han Wu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Su Yang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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15
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Zhang Y, Chen C, Hu J, Han Y, Huang M, Xiang J, Li H. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg 2020; 160:1363-1372. [DOI: 10.1016/j.jtcvs.2019.12.112] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/22/2019] [Accepted: 12/21/2019] [Indexed: 12/23/2022]
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Hu J, Chen Y, Dai J, Zhu X, Gonzalez-Rivas D, Jiang G, Li H, Zhang P. Perioperative outcomes of robot-assisted vs video-assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta-analysis. Int J Med Robot 2020; 16:1-14. [PMID: 32400946 DOI: 10.1002/rcs.2123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The superiority of robot-assisted thoracic surgery (RATS) over video-assisted thoracic surgery (VATS) and thoracotomy remains controversial for lung cancer. METHODS A network meta-analysis (NMA) and pairwise meta-analysis (PMA) were performed to evaluate the perioperative outcomes using five databases. RESULTS Thirty-two studies involving 6593 patients were included for analysis. The NMA showed that RATS had similar operative time, conversion rate to thoracotomy, number of lymph node, postoperative morbidity, and length of hospital stay with VATS, except for lower 30-day mortality. Compared with thoracotomy, longer operative time and shorter hospital stay were observed in RATS, but no significant difference was observed in number of lymph node, postoperative morbidity, and 30-day mortality in both NMA and PMA. In lobectomy/segmentectomy subgroup, all outcomes, except for operative time of RATS vs VATS and number of lymph node, were similar with overall analyses. CONCLUSIONS RATS had comparable perioperative outcomes with VATS and open surgery.
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Affiliation(s)
- Junjie Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinsheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Li
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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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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Zhou Q, Huang J, Pan F, Li J, Liu Y, Hou Y, Song W, Luo Q. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res 2020; 9:306-315. [PMID: 32420070 PMCID: PMC7225141 DOI: 10.21037/tlcr-20-533] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Robotic anatomic segmentectomy (RATS) for early-stage lung cancer is being increasingly performed in spite of limited published evidence. To evaluate its safety and oncologic efficacy, we compared the outcomes of both RATS and video-assisted thoracoscopic (VATS) segmentectomy in patients with small-sized (<2 cm) peripheral stage IA lung cancer. Methods From November 2011 to January 2018, a total of 130 patients with resected stage IA non-small cell lung cancer (NSCLC) who underwent RATS (n=50) and VATS (n=80) pulmonary segmentectomy were included. Clinicopathologic data, recurrence rate, and survival were recorded. Results The demographics, pulmonary function, comorbidity, and tumor size were similar between RATS segmentectomy and VATS segmentectomy. The surgery time, intensive care unit stay, hospital stay, and blood loss were reduced in the RATS group compared to the VATS group. The number of totally dissected lymph nodes and postoperative complications were similar between the 2 groups. There was no operative mortality. The intensity of narcotic use during hospital stay and the time to return to routine daily activities were also reduced in the RATS group. There was no recurrence observed in the RATS group during the median 38-month follow-up period; meanwhile, during a median 85-month follow-up period in the VATS group, local recurrence and distant recurrence was observed in 2 patients (2.5%) and 3 patients (3.75%) respectively. There was no significant difference in the 5-year recurrence-free survival between the RATS and VATS groups (100% vs. 93.75%; P>0.05). Conclusions RATS can be performed safely and effectively in patients with early-stage NSCLC. The reduced narcotic use and earlier return to routine daily activities of RATS patients might reflect its less traumatic nature as compared to VATS. For stage IA disease with small tumors (<2 cm), segmentectomy performed by RATS has better oncologic efficacy when compared to VATS, although in this study, this difference did not reach statistical difference.
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Affiliation(s)
- Qianjun Zhou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jia Huang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Feng Pan
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jiantao Li
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yuan Liu
- Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yucheng Hou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Weijian Song
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Qingquan Luo
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
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Hu X, Wang M. Efficacy and Safety of Robot-assisted Thoracic Surgery (RATS) Compare with Video-assisted Thoracoscopic Surgery (VATS) for Lung Lobectomy in Patients with Non-small Cell Lung Cancer. Comb Chem High Throughput Screen 2020; 22:169-178. [PMID: 30973106 DOI: 10.2174/1386207322666190411113040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/15/2018] [Accepted: 11/02/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND In the past decade, many researchers focused on Robotic- Assisted Thoracoscopic Surgery (RATS), which has been introduced as an alternative minimally invasive approach, versus Video- Assisted Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small cell lung cancer. However, the advantage of RVATS compared to VATS is still under investigation. The results are unclear. AIM The aim of this study is to compare the efficacy and safety of Robot-assisted Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery (VATS) for lobectomy in patients with Non- Small Cell Lung Cancer (NSCLC). METHODS A systematic electronic search of online electronic databases: Pubmed, Embase, Cochrane library updated in June 2017. The meta-analysis was performed including the studies are designed as randomized or non- randomized controlled. RESULTS Twenty retrospective cohort studies met our inclusion criteria. The pooled analysis of mortality showed that RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 - 0.76; P = 0.0005). With the pooled result of duration of surgery indicated that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI 0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length of hospital stay (MD =0.00, 95% CI -0.03 - 0.03; P = 0.91), number of dissected lymph nodes station (SMD =0.39, 95% CI -0.60 - 1.38; P = 0.44), the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 - 2.56; P = 0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 - 0.73; P = 0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93), arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia (RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR =0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90 - 1.23; P = 0.055) all showed no significant differences between RATS and VATS lobectomy. CONCLUSIONS RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some efforts need to be taken into consideration to reduce the operative time and cost.
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Affiliation(s)
- Xun Hu
- Department of Thoracic Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China
| | - Ming Wang
- Department of Thoracic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China
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20
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Li C, Hu Y, Huang J, Li J, Jiang L, Lin H, Lu P, Luo Q. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB-IIIA non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:820-828. [PMID: 32010560 DOI: 10.21037/tlcr.2019.10.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background With the rapid development of surgical technics and instruments, more and more locally advanced non-small cell lung cancer (NSCLC) patients are being treated by minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent lobectomy by these two surgical approaches. Methods We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage IIB-IIIA NSCLC who underwent video-assisted thoracoscopic or robotic lobectomy. Perioperative outcomes, recurrence, and overall survival (OS) were compared. Results From January 2014 to January 2017, there were at total of 121 patients, including 36 robotic lobectomy patients and 85 VATS lobectomy patients. One patient (2.8%) in the RATS group and 5 patients (5.9%) in the VATS group were converted to thoracotomy (P=0.79). No perioperative death was observed in both groups. The postoperative morbidity was similar between the two groups (13.9% for RATS vs. 15.3% for VATS; P=0.84). Robotic lobectomy was associated with a shorter length of postoperative hospital stay (4 vs. 5 d, P<0.01) and more counts of lymph nodes harvested (13 vs. 10, P<0.01). The median disease-free survival (DFS) for the RATS and VATS groups were 31.1 and 33.8 months, respectively. The corresponding 3-year DFS was 40.3% in the RATS group and 47.6% in the VATS group (P=0.74). The 3-year OS was 75.7% in RATS and 77.0% in the VATS group (P=0.75). Conclusions For selected NSCLC patients with lymph node involvement, robotic lobectomy is safe and effective with a low complication rate and similar long-term outcome compared with VATS lobectomy. Moreover, the robotic approach resulted in shorter postoperative length of stay and greater lymph node assessment.
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Affiliation(s)
- Chongwu Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Yingjie Hu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jia Huang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jiantao Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Long Jiang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Hao Lin
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Peiji Lu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai 200030, China
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Abstract
: Objective: To compare the safety/efficacy of the robotic-assisted lobectomy/segmentectomy (RAL/S) with the video-assisted lobectomy/segmentectomy (VAL/S) for radical lung cancer resection. BACKGROUND It remains uncertain whether the newly developed RAL/S is comparable with the VAL/S. METHODS A comprehensive search of online databases was performed. Perioperative outcomes were synthesized. Cumulative meta-analysis was performed to evaluate the temporal trend of pooled outcomes. Specific subgroups (propensity score matching studies, pure lobectomy studies) were examined. RESULTS Analysis of 14 studies including a total of 7438 patients was performed. RAL/S was performed on 3239 patients, whereas the other 4199 patients underwent VAL/S. The 30-day mortality [0.7% vs 1.1%; odds ratio (OR) 0.53, P = 0.045] and conversion rate to open surgery (10.3% vs 11.9%; OR 0.57, P < 0.001) were significantly lower in patients who underwent RAL/S than VAL/S. Meanwhile, the postoperative complications (27.5% vs 28.2%; OR 0.95, P = 0.431), operation time [176.63 vs 162.74 min; standardized mean difference (SMD) 0.30, P = 0.086], duration of hospitalization (4.90 vs 5.23 days; SMD -0.08, P = 0.292), days to tube removal (4.10 vs 3.53 days; SMD 0.25, P = 0.120), retrieved lymph node (11.96 vs 10.67; SMD 0.46, P = 0.381), and retrieved lymph node station (4.98 vs 4.32; SMD 0.83, P = 0.261) were similar between the 2 groups. The cumulative meta-analyses suggested that the relative effects between 2 groups have already stabilized. All outcomes of subgroup and overall analyses were similar. CONCLUSIONS This up-to-date meta-analysis confirms that RAL/S is a feasible and safe alternative to VAL/S for radical resection of lung cancer. Future studies should focus on the long-term benefits and cost effectiveness of RAL/S compared with VAL/S.
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Guo F, Ma D, Li S. Compare the prognosis of Da Vinci robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS) for non-small cell lung cancer: A Meta-analysis. Medicine (Baltimore) 2019; 98:e17089. [PMID: 31574808 PMCID: PMC6775418 DOI: 10.1097/md.0000000000017089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.
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Xie B, Sun X, Qin Y, Liu A, Miao S, Jiao W. Short-term outcomes of typical versus atypical lung segmentectomy by minimally invasive surgeries. Thorac Cancer 2019; 10:1812-1818. [PMID: 31373437 PMCID: PMC6718014 DOI: 10.1111/1759-7714.13152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/27/2022] Open
Abstract
Background Segmentectomy is increasingly used to resect lung nodules. Robotic‐assisted thoracic surgery (RATS) is considered a safe and practical method for segmentectomy. Few studies have compared robotic surgery and video‐assisted thoracic surgery (VATS) for lung segmentectomy. Method We retrospectively examined 215 consecutive patients who underwent typical (88 patients) or atypical (128 patients) segmentectomy by either robotic surgery or VATS. The postoperative characteristics including operation time, blood loss, pneumonia, tumor size, lymph nodes harvested, chest tube duration, prolonged air leak, atrial fibrillation, and postoperative hospital stay were recorded. Results A total of 88 patients underwent typical segmentectomy, while 127 patients underwent atypical segmentectomy. A greater number of lymph nodes were resected via RATS than by VATS (13.24 ± 4.84 vs. 11.71 ± 3.89; P = 0.018). The operation time for typical segmentectomy was shorter than that for atypical segmentectomy (115.69 ± 22.32 vs. 131.68 ± 22.52; P = 0). No significant differences were found between RATS and VATS in terms of chest drainage duration and postoperative hospital stay. The incidence of postoperative complications including prolonged air leak and atrial fibrillation was not significantly different between typical segmentectomy and atypical segmentectomy. Conclusion Atypical segmentectomy is more complicated than typical segmentectomy, which may lead to increases in complications and operation time. Robotic surgery was safe and practical for segmentectomy compared to VATS and more lymph nodes could be dissected by RATS without increasing the risk of postoperative complications.
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Affiliation(s)
- Boheng Xie
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.,No.1 People's Hospital, Ningyang county, China
| | - Xiao Sun
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ao Liu
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuncheng Miao
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Division of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Zhang Y, Liu S, Han Y, Xiang J, Cerfolio RJ, Li H. Robotic Anatomical Segmentectomy: An Analysis of the Learning Curve. Ann Thorac Surg 2019; 107:1515-1522. [DOI: 10.1016/j.athoracsur.2018.11.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 12/01/2022]
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Geraci TC, Ferrari-Light D, Kent A, Michaud G, Zervos M, Pass HI, Cerfolio RJ. Technique, Outcomes With Navigational Bronchoscopy Using Indocyanine Green for Robotic Segmentectomy. Ann Thorac Surg 2019; 108:363-369. [PMID: 30980818 DOI: 10.1016/j.athoracsur.2019.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The objectives of this study were to present outcomes of robotic segmentectomy and the investigators' preferred technique for nodule localization using indocyanine green both bronchoscopically and intravenously. METHODS This study was a retrospective review of a consecutive series of patients scheduled for robotic segmentectomy from a single surgeon's prospectively collected database. RESULTS Between January 2010 and October 2018, there were 245 consecutive patients who underwent planned robotic segmentectomy by one surgeon. Of these 245 patients, 93 (38%) received indocyanine green by electromagnetic navigational bronchoscopy, and all 245 received intravenous indocyanine green. Median time for navigational bronchoscopy was 9 minutes. Navigational bronchoscopy with indocyanine green correctly identified the lesion in 80 cases (86%). The preferred technique was as follows: 0.5 mL of 25 mg of indocyanine green diluted in 10 mL of sterile water given bronchoscopically, followed by a 0.5-mL saline flush, staying at least 4 mm from the pleural surface. The remaining 9.5 mL of indocyanine green was administered intravenously after pulmonary artery ligation. An R0 resection was achieved in all 245 patients, a median of 17 lymph nodes were resected, and the average length of stay was 3.1 days (range, 1 to 21 days). Major morbidity occurred in 3 patients, and there were no 30- or 90-day mortalities. CONCLUSIONS Robotic segmentectomy is safe, with excellent early clinical outcomes. In this series, electromagnetic navigational bronchoscopy and indocyanine green localization were efficient and effective at identifying the target lesion. Intravenous indocyanine green delineated the intersegmental plane.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | - Dana Ferrari-Light
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Amie Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Gaetane Michaud
- Department of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, New York
| | - Michael Zervos
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
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Li JT, Huang J, Luo QQ. Robotic-assisted right medial and anterior basal segmentectomy (S7+S8). J Thorac Dis 2019; 11:240-242. [PMID: 30863594 PMCID: PMC6384338 DOI: 10.21037/jtd.2018.12.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
Anatomical segmentectomy for medial (S7) and anterior basal segments (S8) is still challenging even with substantial progress in surgical technique over these years. We believe that segmentectomy could be much more comfortable with the application of the da Vinci surgical system in thoracic surgery. With nearly 10-year experience of robotic thoracic surgery, we gradually develop a new way of port placement and surgery. Here we present a step-by-step right medial and anterior basal segmentectomy (S7+S8) with a high-quality video and preference cards.
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Affiliation(s)
- Jian-Tao Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Jia Huang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Qing-Quan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
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Terra RM, Lauricella LL, Haddad R, de-Campos JRM, Nabuco-de-Araujo PHX, Lima CET, Santos FCBD, Pego-Fernandes PM. Segmentectomia pulmonar anatômica robótica: aspectos técnicos e desfechos. Rev Col Bras Cir 2019; 46:e20192210. [DOI: 10.1590/0100-6991e-20192210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: relatar nossa experiência inicial com a segmentectomia robótica, descrevendo a técnica operatória, a colocação preferencial dos portais, os resultados iniciais e desfechos. Métodos: dados clínicos de pacientes submetidos à segmentectomia robótica, entre janeiro de 2017 e dezembro de 2018, foram obtidos de um banco de dados prospectivo de cirurgia robótica. Todos os pacientes tinham câncer de pulmão, primário ou secundário, ou doenças benignas, e foram operados usando o sistema Da Vinci com a técnica de três portais mais uma incisão utilitária de 3cm. As estruturas hilares foram dissecadas individualmente e as ligaduras dos ramos arteriais e venosos, dos brônquios segmentares, assim como, a transecção do parênquima, realizadas com grampeadores endoscópicos. Dissecção sistemática dos linfonodos mediastinais foi realizada para os casos de câncer de pulmão não de pequenas células (CPNPC). Resultados: quarenta e nove pacientes, dos quais 33 mulheres, foram submetidos à segmentectomia robótica. A média de idade foi de 68 anos. A maioria dos pacientes tinha CPNPC (n=34), seguido de doença metastática (n=11) e doenças benignas (n=4). Não houve conversão para cirurgia aberta ou vídeo, ou conversão para lobectomia. A mediana do tempo operatório total foi de 160 minutos e do tempo de console foi de 117 minutos. Complicações pós-operatórias ocorreram em nove pacientes (18,3%), dos quais sete (14,2%) tiveram internação prolongada (>7 dias) devido à fístula aérea persistente (n=4; 8,1%) ou complicações abdominais (n=2; 4%). Conclusão: a segmentectomia robótica é um procedimento seguro e viável, oferecendo curto período de internação e baixa morbidade.
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Affiliation(s)
| | - Leticia Leone Lauricella
- Hospital Sírio Libanês, Brasil; Universidade de São Paulo, Brasil; Hospital São Luiz Itaim - Rede D'Or, Brasil
| | - Rui Haddad
- Pontifícia Universidade Católica do Rio de Janeiro, Brasil; Hospital Copa Star, Brasil; Hospital Quinta D'Or - Rede D'Or, Brasil
| | | | | | - Carlos Eduardo Teixeira Lima
- Pontifícia Universidade Católica do Rio de Janeiro, Brasil; Hospital Copa Star, Brasil; Hospital Quinta D'Or - Rede D'Or, Brasil
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Robotic Approach to Combined Anatomic Pulmonary Subsegmentectomy: Technical Aspects and Early Results. Ann Thorac Surg 2018; 107:1480-1486. [PMID: 30594580 DOI: 10.1016/j.athoracsur.2018.11.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/15/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimally invasive techniques are increasingly being used in pulmonary segmentectomy and combined subsegmentectomy. However, there are no reports as yet on robotic combined anatomic subsegmentectomy (CAS). In this report, we describe related clinical data and operative techniques and present our early results. METHODS Clinical data of patients undergoing robotic CAS were retrospectively reviewed. A combined subsegmentectomy was defined as the resection of 2 or more subsegments that involved 2 or more adjacent segments. The study enrolled patients who underwent completely portal robotic CAS. RESULTS Between May 2015 and January 2018, a single surgeon performed completely portal robotic CAS for 16 patients. In the CAS-treated patients, 75% of the lesions were located in the right upper lobe, and none required conversion to thoracotomy. Median operative time was 175 minutes (range, 75 to 294 minutes), and mean postoperative hospital stay was 4 days (range, 2 to 11 days). Although 1 patient experienced a prolonged air leak, the other 15 recovered uneventfully. Within a median follow-up period of 15 months, there were no deaths or tumor recurrences. CONCLUSIONS Completely portal robotic CAS is a safe and effective procedure in a select subset of patients, proving quite suitable for smaller (<2 cm) multisegment lung cancers, particularly lesions of the right upper lobe. A robotics approach facilitates complex and challenging CAS, the disadvantage being lengthy operative times during early acquisition of skills.
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Nakazawa S, Shimizu K, Mogi A, Kuwano H. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg 2017; 66:81-90. [PMID: 29255967 DOI: 10.1007/s11748-017-0878-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Affiliation(s)
- Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Sakanoue I, Hamakawa H, Imai Y, Takahashi Y. Thoracoscopic Surgery for a Congenital Bronchoesophageal Fistula With Pulmonary Sequestration in an Adult Woman. Semin Thorac Cardiovasc Surg 2017; 29:433-435. [PMID: 29195580 DOI: 10.1053/j.semtcvs.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 11/11/2022]
Abstract
A congenital bronchoesophageal fistula with pulmonary sequestration is rare in adults. Here, we report the case of an adult woman having congenital bronchoesophageal fistula with intralobar pulmonary sequestration who successfully underwent thoracoscopic resection and showed a good postoperative course.
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Affiliation(s)
- Ichiro Sakanoue
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Hiroshi Hamakawa
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Takahashi
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Wei B, Cerfolio R. Technique of robotic segmentectomy. J Vis Surg 2017; 3:140. [PMID: 29302416 DOI: 10.21037/jovs.2017.08.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022]
Abstract
Robotic segmentectomy can be a useful technique for patients with suboptimal pulmonary reserve, or for small peripheral stage I tumors. Port placement and conduct of operation is described for the various segmentectomies. Results for robotic segmentectomy are comparable to that for video-assisted thoracoscopic surgery (VATS) segmentectomy.
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Affiliation(s)
- Benjamin Wei
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL, USA
| | - Robert Cerfolio
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL, USA
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Cerfolio R, Louie BE, Farivar AS, Onaitis M, Park BJ. Consensus statement on definitions and nomenclature for robotic thoracic surgery. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.02.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Emmert A, Straube C, Buentzel J, Roever C. Robotic versus thoracoscopic lung resection: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7633. [PMID: 28858083 PMCID: PMC5585477 DOI: 10.1097/md.0000000000007633] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Robotic video-assisted surgery (RVATS) has been reported to be equally effective to video-assisted surgery (VATS) in lung resection (pneumonectomy, lobectomy, and segmentectomy). Operation time, mortality, drainage duration, and length of hospitalization of patients undergoing either RVATS or VATS are compared in this meta-analysis. METHODS A systematic research for articles meeting our inclusion criteria was performed using the PubMed database. Articles published from January 2011 to January 2016 were included. We used results of reported mortality, operation time, drainage duration, and hospitalization length for performing this meta-analysis. Mean difference and logarithmic odds ratio were used as summary statistics. RESULTS Ten studies eligible were included into this analysis (5 studies for operation time, 3 studies for chest in tube days, 4 studies for length of hospitalization, and 6 studies for mortality). We were able to include 3375 subjects for RVATS and 58,683 subjects for VATS. Patients were mainly treated for lung cancer, metastatic foci, and benign lesions. We could not detect any difference between operation time; however, we found 2 trends showing that drainage duration and length of hospitalization are shorter for following RVATS than for following VATS. Mortality also is lower in patients undergoing RVATS. CONCLUSIONS Therefore, we conclude that RVATS is a suitable minimal-invasive procedure for lung resection and suitable alternative to VATS. RVATS is as time-efficient as VATS and shows a trend to reduced hospital stay and drainage duration. More and better studies are required to provide reliable, unbiased evidence regarding the relative benefits of both methods.
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Affiliation(s)
| | | | | | - Christian Roever
- Department of Medical Statistics, University Medical Center, Georg-August University, Göttingen, Germany
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35
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Yu Z, Xie Q, Guo L, Chen X, Ni C, Luo W, Li W, Ma L. Perioperative outcomes of robotic surgery for the treatment of lung cancer compared to a conventional video-assisted thoracoscopic surgery (VATS) technique. Oncotarget 2017; 8:91076-91084. [PMID: 29207626 PMCID: PMC5710907 DOI: 10.18632/oncotarget.19533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To conduct a meta-analysis to determine the relative merits between robotic video-assisted thoracoscopic surgery (R-VATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer. Results Fifteen studies matched the selection criterion, which reported 8827 subjects, of whom 1704 underwent R-VATS and 7123 underwent VATS. Compared the perioperative outcomes with VATS, reports of R-VATS indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% CI 0.15 to 0.81). Meanwhile, the number of dissected lymph nodes (SMD = 0.12, 95% CI -0.27 to 0.51) and hospital stay following surgery (SMD = -0.1; 95% CI -0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures. Materials and Methods A literature search was performed to identify comparative studies reporting perioperative outcomes for R-VATS and VATS for lung cancer. Pooled risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model. Conclusions There is no difference in terms of perioperative outcomes between R-VATS and VATS except for the operative time which is significantly high for R-VATS. Further studies are required to confirm these results.
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Affiliation(s)
- Zipu Yu
- Department of Thoracic Surgery, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qiong Xie
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lei Guo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenyao Ni
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wenzong Luo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
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Toker A, Kaba E, Ayalp K, Özyurtkan MO. Robotic lung resections: video-assisted thoracic surgery based approach. J Vis Surg 2017; 3:15. [PMID: 29078578 DOI: 10.21037/jovs.2017.01.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 11/06/2022]
Abstract
Advances in technology cause major developments in minimally invasive thoracic surgery practice. The expected benefits of minimally invasive pulmonary surgery are clear and mostly as follows; shorter hospital stay, fast recovery, less pain, and decreased morbidity and mortality. Robotic surgery with improved visualization and instrumental technical capabilities has become an attractive tool for surgeons who are performing lung resections. However, robotic surgery still seems far away from standardization even in the basic fundamental which is "the best approach for docking". In this article, we would like to share our experience in robotic surgery with video-assisted thoracic surgery (VATS) based or in other terms "robotic-assisted" approach, and discuss its advantages and disadvantages. We speculate that, especially at early experience, VATS based approach or "robotic-assisted approach" may provide a smooth start up with the support of the experienced table surgeon.
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Affiliation(s)
- Alper Toker
- Group Florence Nightingale Hospitals, Istanbul Florence Hospital, Istanbul, Turkey
| | - Erkan Kaba
- Department of Thoracic Surgery, University of Science, Şişli-Istanbul, Turkey
| | - Kemal Ayalp
- Group Florence Nightingale Hospitals, Istanbul Florence Hospital, Istanbul, Turkey
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Veronesi G, Novellis P, Voulaz E, Alloisio M. Robot-assisted surgery for lung cancer: State of the art and perspectives. Lung Cancer 2016; 101:28-34. [DOI: 10.1016/j.lungcan.2016.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 12/29/2022]
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Baste JM, Rinieri P, Sarsam M, Peillon C. Place de la chirurgie robotique dans les pathologies tumorales thoraciques. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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One Hundred Planned Robotic Segmentectomies: Early Results, Technical Details, and Preferred Port Placement. Ann Thorac Surg 2016; 101:1089-95; Discussion 1095-6. [PMID: 26846343 DOI: 10.1016/j.athoracsur.2015.08.092] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/03/2015] [Accepted: 08/19/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Both robotic pulmonary operations and anatomic segmentectomy are being increasingly performed. The largest published series of anatomic robotic segmentectomy comprises 35 patients, and the specific details of port placement are poorly understood. METHODS This is a review of a consecutive series of patients from a single surgeon's prospective database. All patients in the study were scheduled to undergo robotic anatomic segmentectomy. RESULTS Between February 2010 and December 2014, 100 patients went to the operating room for a planned pulmonary segmentectomy. A robotic approach was chosen for all. Seven patients underwent conversion to robotic lobectomy, and the remaining 93 patients had an anatomic robotic segmentectomy. There were no conversions to thoracotomy. Indications for resection were lung cancer in 79 patients, metastatic lesions in 10 patients, fungal infections in 4 patients, and other conditions in 7 patients. The median age was 69 years, and 50 patients were men. The median blood loss was 20 mL (range, 10-120 mL), the median number of lymph nodes removed was 19, the median operative time was 1.28 hours (88 minutes), the median length of stay was 3 days, and major morbidity occurred in 2 patients (pneumonia in both). All had undergone R0 resection. There were no 30- or 90-day mortalities. Of the 79 patients with lung cancer, the median follow-up was 30 months, and 3 patients (3.4%) had recurrence in the operated lobe. Overall survival was 95% at 30 months. CONCLUSIONS Completely portal robotic anatomic segmentectomy is safe and effective and offers outstanding intraoperative 30-day and 90-day results. The recurrence rate is approximately 3% at 2.5 years.
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40
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Agzarian J, Fahim C, Shargall Y, Yasufuku K, Waddell TK, Hanna WC. The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review. Semin Thorac Cardiovasc Surg 2016; 28:182-92. [DOI: 10.1053/j.semtcvs.2016.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 11/11/2022]
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Toker A, Özyurtkan MO, Kaba E, Nova G. Da Vinci Robotic System in the surgery for mediastinal bronchogenic cyst: a report on five patients. J Vis Surg 2015; 1:23. [PMID: 29075613 DOI: 10.3978/j.issn.2221-2965.2015.11.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/26/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND To present the results of the patients with mediastinal bronchogenic cysts that underwent robotic surgery using Da Vinci Robotic System in our institution. METHODS Five patients with mediastinal bronchogenic cyst undergoing robotic resection between October 2011 and September 2015 were retrospectively evaluated. Their pre-, peri- and post-operative results were investigated. RESULTS There were five patients (male/female: 3/2) with a mean age of 43±28 years. Three patients (60%) were asymptomatic. The lesions had been detected in the remaining two patients during the investigation of cough and abdominal pain. All the lesions were located at the posterior mediastinum. The mean diameter of lesion was 48±17 mm. One patient underwent robotic decortication in addition to robotic cystectomy. Operative times are outlined as: mean docking time 20±12 min, mean console time 63±32 min, and mean operating time 88±41 min. The mean length of stay was 3.6±2.2 days. There was no mortality or morbidity. CONCLUSIONS Bronchogenic cyst is among the commonest congenital lesions. The treatment is surgical resection, and mostly via thoracotomy and video-assisted thoracic surgery (VATS). There exist less than 15 patients who underwent robotic resection in the English literature, and most of them are presented as single case reports. Robotic resection of mediastinal bronchogenic cysts could be considered as a safe method.
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Affiliation(s)
- Alper Toker
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Erkan Kaba
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Greta Nova
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
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Ye X, Xie L, Chen G, Tang JM, Ben XS. Robotic thoracic surgery versus video-assisted thoracic surgery for lung cancer: a meta-analysis. Interact Cardiovasc Thorac Surg 2015; 21:409-14. [DOI: 10.1093/icvts/ivv155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/18/2015] [Indexed: 11/12/2022] Open
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Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc 2015; 30:676-683. [DOI: 10.1007/s00464-015-4259-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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