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Khan JA, Albalkhi I, Garatli S, Migliore M. Recent Advancements in Minimally Invasive Surgery for Early Stage Non-Small Cell Lung Cancer: A Narrative Review. J Clin Med 2024; 13:3354. [PMID: 38893066 PMCID: PMC11172429 DOI: 10.3390/jcm13113354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Lung cancer remains a global health concern, with non-small cell lung cancer (NSCLC) comprising the majority of cases. Early detection of lung cancer has led to an increased number of cases identified in the earlier stages of NSCLC. This required the revaluation of the NSCLC treatment approaches for early stage NSCLC. Methods: We conducted a comprehensive search using multiple databases to identify relevant studies on treatment modalities for early stage NSCLC. Inclusion criteria prioritized, but were not limited to, clinical trials and meta-analyses on surgical approaches to early stage NSCLC conducted from 2021 onwards. Discussion: Minimally invasive approaches, such as VATS and RATS, along with lung resection techniques, including sublobar resection, have emerged as treatments for early stage NSCLC. Ground-glass opacities (GGOs) have shown prognostic significance, especially when analyzing the consolidation/tumor ratio (CTR). There have also been updates on managing GGOs, including the non-surgical approaches, the extent of lung resection indicated, and the level of lymphadenectomy required. Conclusions: The management of early stage NSCLC requires a further assessment of treatment strategies. This includes understanding the required extent of surgical resection, interpreting the significance of GGOs (specifically GGOs with a high CTR), and evaluating the efficacy of alternative therapies. Customized treatment involving surgical and non-surgical interventions is essential for advancing patient care.
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Affiliation(s)
- Jibran Ahmad Khan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (J.A.K.); (I.A.); (S.G.)
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (J.A.K.); (I.A.); (S.G.)
| | - Sarah Garatli
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (J.A.K.); (I.A.); (S.G.)
| | - Marcello Migliore
- Thoracic Surgery & Lung Transplant, Lung Health Centre, Organ Transplant Center of Excellence (OTCoE), King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
- Department of Surgery & Medical Specialties, University of Catania, 96100 Catania, Italy
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Chen M, Huang Y, Hu J, Jia L, Wu Y, Feng J, Zhang F, Tong J, Chen Q, Li H. Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery. Surg Endosc 2024; 38:2795-2804. [PMID: 38589593 DOI: 10.1007/s00464-024-10789-9] [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: 01/09/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. METHODS We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. RESULTS Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. CONCLUSIONS We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.
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Affiliation(s)
- Maodan Chen
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Yang Huang
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Juyi Hu
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Longfei Jia
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Yuanzhou Wu
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Jing Feng
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Fuwei Zhang
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Jian Tong
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Qunqing Chen
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Hui Li
- Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, No. 253 Gongye Middle Avenue, Haizhu District, Guangzhou, Guangdong, China.
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Lee JH, Park TH, Kim HK. Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00206-X. [PMID: 38678475 DOI: 10.1016/j.jtcvs.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE This study aimed to report the initial experiences of 115 patients who underwent robotic thoracic surgery using the da Vinci single-port robotic surgical system (Intuitive Surgical). METHODS Robotic thoracic surgery using the da Vinci single-port robotic surgical system was performed on 115 patients between November 2020 and June 2023. Patient characteristics, intraoperative outcomes, and postoperative outcomes were analyzed retrospectively. RESULTS The type of surgeries included thymectomy, mediastinal mass excision, anatomical pulmonary resection (including lobectomy and segmentectomy), esophagectomy, and enucleation of esophageal submucosal tumors in 41, 13, 54, 5, and 2 patients, respectively. The mean total operative time and chest tube duration for different procedures were as follows: thymectomy, 152.9. ± 6.7 minutes and 1.2 ± 0.5 days; mediastinal mass excision, 93.3 ± 26.5 minutes and 1.0 ± 0 days; anatomical pulmonary resection, 187.2 ± 55.8 minutes and 2.5 ± 1.5 days; esophagectomy, 485 ± 111.9 minutes and 12 ± 4.6 days; and enucleation of esophageal submucosal tumors, 170 ± 30 minutes and 5.5 ± 0.5 days, respectively. Conversion to a thoracotomy or sternotomy was not required. Conversion to video-assisted thoracic surgery occurred in 1 patient, and an additional port was applied in 2 patients. Two patients experienced postoperative complications greater than grade IIIa. CONCLUSIONS Robotic thoracic surgery using the da Vinci single-port robotic surgical system is feasible and safe in various fields of thoracic surgery, including complex procedures such as anatomical pulmonary resection and esophagectomy. More complex thoracic surgeries can be performed with the continuous advancement and innovation of instruments in robotic systems.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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4
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Chao YK, Lee JY, Lu HI, Tseng YL, Lee JM, Huang WC. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: a multi-institutional study. J Robot Surg 2024; 18:21. [PMID: 38217569 DOI: 10.1007/s11701-023-01745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
Anterior mediastinal procedures are increasingly being performed using robot-assisted thoracic surgery (RATS) or video-assisted thoracoscopic surgery (VATS). While both approaches have shown superior outcomes compared to open surgery, their comparative benefits are not as distinct. The aim of this retrospective study was to bridge this knowledge gap using a multicenter dataset. Patients who underwent elective minimally invasive surgery for anterior mediastinal disease between 2015 and 2022 were deemed eligible. The study participants were grouped based on whether a robot was used or not, and perioperative outcomes were compared. To mitigate selection bias, inverse probability of treatment weighting (ITPW) was applied using the propensity score. The final analysis included 312 patients (RATS = 120; VATS = 192). Following the application of IPTW, RATS was found to be associated with a longer operating time (215.3 versus 139.31 min, P < 0.001), fewer days with a chest tube (1.96 versus 2.61 days, P = 0.047), and a shorter hospital stay (3.03 versus 3.91 days, P = 0.041) compared to VATS. Subgroup analyses indicated that the benefit of RATS in reducing the length of hospital stay was particularly pronounced in patients with tumors larger than 6 cm (mean difference [MD] = - 2.28 days, P = 0.033), those diagnosed with myasthenia gravis (MD = - 3.84 days, P = 0.002), and those who underwent a trans-subxiphoid surgical approach (MD = - 0.81 days, P = 0.04). Both VATS and RATS are safe and effective approaches for treating anterior mediastinal disease. However, RATS holds distinct advantages over VATS including shorter hospital stays and reduced chest tube drainage periods.
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Affiliation(s)
- Yin-Kai Chao
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan.
| | - Jui-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hung-I Lu
- Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial Hospital-Kaohsiung, Chang Gung University, Kaohsiung, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Chien Huang
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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5
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Sezen CB, Dogru MV, Tanrıkulu G, Aker C, Erduhan S, Saydam O, Metin M. Comparison of short-term results of subxiphoid and conventional video-assisted thoracoscopic surgery in diagnostic wedge resections. Asian Cardiovasc Thorac Ann 2023; 31:115-122. [PMID: 36366742 DOI: 10.1177/02184923221138307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study aimed to compare early results in patients who underwent subxiphoid wedge resection with those operated on using a multiportal approach. METHODS We retrospectively evaluated 151 patients who underwent diagnostic wedge resection for suspected interstitial lung disease. Patients who underwent wedge resection via subxiphoid video-assisted thoracoscopic surgery and conventional video-assisted thoracoscopic surgery were compared. RESULTS The study included 90 men (59.6%) and 61 women (40.4%) with a mean age of 54.8 ± 12 years. Of these, 127 patients underwent conventional video-assisted thoracoscopic surgery and 24 patients underwent subxiphoid video-assisted thoracoscopic surgery. Postoperative complications occurred in 13 patients (8.6%), with no significant difference according to surgical technique. Sex was a significant factor in the rate of complications (12.2% in men vs. 3.2% in women). There was no intraoperative mortality; the 30-day mortality rate was 4% (n = 6). Five nonsurviving patients were in the conventional video-assisted thoracoscopic surgery group and 1 was in the subxiphoid video-assisted thoracoscopic surgery group (p = 0.95). CONCLUSION The results of this study indicate that the subxiphoid approach reduced procedure time and length of hospital stay in the early period, while there was no significant difference between the techniques in terms of complications or mortality. Based on these findings, we conclude that surgical outcomes were as successful with the subxiphoid approach as with conventional video-assisted thoracoscopic surgery.
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Affiliation(s)
- Celal Bugra Sezen
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Vedat Dogru
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gamze Tanrıkulu
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Erduhan
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Saydam
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Health of Sciences University, 147022Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Wu CF, Cheng C, Suen KH, Stein H, Chao YK. A Preclinical Feasibility Study of Single-Port Robotic Subcostal Anatomical Lung Resection and Subxiphoid Thymectomy Using the da Vinci ® SP System. Diagnostics (Basel) 2023; 13:diagnostics13030460. [PMID: 36766565 PMCID: PMC9914746 DOI: 10.3390/diagnostics13030460] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Despite the recent introduction of technologically advanced single-port (SP) robotic systems, their use in the field of thoracic surgery has been rarely explored. Here, we report our preclinical experience concerning SP robotic thoracic surgery using the da Vinci® SP system. The da Vinci® SP system was used to perform subcostal anatomical lung resection and subxiphoid thymectomy in three cadavers. The operative settings that best met the surgeon's requirements for each resection were also determined. Four subcostal anatomical lung resections and two subxiphoid thymectomies were completed. While both procedures did not require additional incisions, the use of an observation port in the intercostal spaces was strongly recommended to safely create subcostal access. Dissection of hilar structures and mediastinal lymph nodes was feasible. However, due to the current unavailability of a robotic stapler, a handheld stapling instrument was required to perform a transection of vital structures. When the stapling process proved to be difficult, the table surgeon temporarily removed a robotic arm to acquire the necessary space to complete the procedure. Our data represent a promising preclinical step in understanding the feasibility of using the da Vinci® SP system to perform an SP subcostal anatomical lung resection and a subxiphoid thymectomy.
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Affiliation(s)
- Ching Feng Wu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333323, Taiwan
| | - Chuan Cheng
- Division of Thoracic Surgery, New Taipei Municipal Tu-Cheng Hospital, New Taipei City 25162, Taiwan
| | - Ka Hei Suen
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA 94086, USA
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA 94086, USA
| | - Yin Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333323, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 2118); Fax: +886-3-3285818
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Shi W, Hu Y, Chang G, Zheng H, Yang Z, Zhao X, Yang Y, Li X. Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases. BMC Surg 2022; 22:386. [DOI: 10.1186/s12893-022-01841-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Objective
To discuss the application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules in both lungs.
Methods
A retrospective analysis of 10 patients in Zhengzhou People’s Hospital who underwent single-incision thoracoscopic surgery to treat multiple nodules in both lungs at the same time from September 2019 to January 2021, and analyze the perioperative indicators (general condition, smoking history, family history, follow-up time of pulmonary nodules, size, location, height and weight, pulmonary function, intraoperative blood loss, operation time, color and volume of drainage fluid, catheterization time, perioperative complications, length of stay, pathology, patient satisfaction, etc.).
Results
All 10 patients used single-incision thoracoscopy to complete bilateral simultaneous sequential operations, aged 32 to 70 years, 8 female patients, 2 male patients, preoperative follow-up time ranging from 1 day to 2 years, a total of 23 lung nodules were removed except for the benign lesions in one nodule in the 2 patients, the other nodules were tumorous lesions (91.3%). The average total hospital stay was 10.5 days (8–14 days), and the average operation time was 194.5 min (145–292 min). The blood loss ranged from 10 to 280 ml, all patients had no serious complications during the perioperative period, and they recovered well and were discharged smoothly, and the satisfaction reached 100%.
Conclusion
Single-incision bilateral simultaneous sequential thoracoscopy have certain advantages in the treatment of patients with multiple nodules in both lungs, conforms to the concept of rapid recovery, and is a feasible choice in the shared decision making of doctors and patients.
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Vishnu R, Jung W, Chia-Hui Shih B, Hwang Y, Jeon JH, Cho S, Kim K, Jheon S. Subcostal robotic-assisted pulmonary resection: Left lingular segmentectomy. JTCVS Tech 2022; 16:149-152. [PMID: 36510517 PMCID: PMC9735356 DOI: 10.1016/j.xjtc.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Woohyun Jung
- Address for reprints: Woohyun Jung, MD, Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
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9
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Park S. Robot-Assisted Thoracic Surgery Thymectomy. J Chest Surg 2021; 54:319-324. [PMID: 34353974 PMCID: PMC8350461 DOI: 10.5090/jcs.21.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Robotic thymectomy has been adopted recently and has been shown to be safe and feasible in treating thymic tumors and myasthenia gravis. The surgical indications of robotic technology are expanding, with advantages including an excellent surgical view and sophisticated manipulation. Herein, we describe technical aspects, considerations, and outcomes of robotic thymectomy.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kang CH, Na KJ, Song JW, Bae SY, Park S, Park IK, Kim YT. The robotic thymectomy via the subxiphoid approach: technique and early outcomes. Eur J Cardiothorac Surg 2021; 58:i39-i43. [PMID: 32061085 DOI: 10.1093/ejcts/ezaa006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/27/2019] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Robotic thymectomy via the subxiphoid approach (RTX) is a recently introduced surgical approach. This study aimed to report on the surgical technique and early outcomes of RTX in our institute. METHODS RTX was performed using the 3-arm technique in the da Vinci robotic surgical system. The camera was inserted into a subxiphoid port, and 2 robotic arms were inserted in bilateral intercostal ports. A complete dissection of both cervical poles up to the thyroid gland was conducted, and bilateral phrenic nerves were identified in all cases. Radical combined resection of adjacent organs, including the lung, pericardium, phrenic nerve and the innominate vein, was performed if necessary. The resected specimen could be retrieved through the subxiphoid port site. RESULTS A total of 110 patients underwent RTX in our institute from October 2016 to August 2019. Thymoma was the most common diagnosis (60.9%), and the mean size of the tumours was 4.9 ± 2.4 cm. Combined resection was performed in the lung (n = 9, 8.1%), pericardium (n = 6, 5.5%) and innominate vein (n = 5, 4.5%). There were 2 minor postoperative complications (1.8%), and the mean length of hospital stay was 2.2 ± 1.4 days. For the cumulative sum curve analysis of the learning curve using operative time, 50 cases were necessary to gain proficiency. CONCLUSIONS RTX was a safe and feasible surgical approach, even in advanced thymic epithelial tumours. It should be considered one of the valuable surgical options in minimally invasive thymectomy.
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Affiliation(s)
- Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - So Young Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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11
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Vinh VH, Quang NVD, Thanh DDM, Van Le Phong T. Robotic video-assisted thoracoscopic surgery using multiport triangular trocar configuration: initial experience at a single center. J Cardiothorac Surg 2021; 16:77. [PMID: 33849581 PMCID: PMC8045230 DOI: 10.1186/s13019-021-01455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent developments in robotic technology have brought significant changes in robotic video-assisted thoracoscopic surgery (r-VATS) worldwide, particularly including the treatment in the thorax for the mediastinal, esophagus, and pulmonary lesions. Currently, there are only a few reports describing the procedural experience and outcomes with r-VATS. The objective of this study is to provide our initial experience using r-VATS at a single center, with specific attention to safety, efficacy, and procedural details. Methods We retrospectively reviewed patients who underwent a newly modified r-VATS procedure for various surgical operations at the thoracic department of our hospital, from July 2018 to January 2020. Multiport trocars were placed in the classic triangular arrangement as in conventional VATS (c-VATS) but with modifications based on the type of surgery. The peri- and postoperative outcomes such as duration of surgery, complications, and duration of hospital stay for these patients were reported. Results Overall, 142 patients underwent r-VATS for lobectomy (66), wedge resection (15), thymectomy (22), mediastinal tumor resection (30), pneumonectomy (4), transthoracic esophagectomy (1), esophageal tumor resection or esophageal diverticulum repair (2), diaphragm plication (1), and mediastinal tumor resection plus thymectomy (1). For the entire cohort, the median operative time was 110 min, and the median length of hospital stay was 5 days. Conversion to open thoracic surgery was reported only in a total of 3 (2.1%) patients of pneumonectomy (1.4%) and mediastinal tumor resection (0.70%). All our patients were managed successfully with no postoperative complications and mortality. Conclusion Our method of r-VATS was found to be safe and effective and may be applied to different surgical operations. Adequate and proper training of thoracic surgeons is immediately needed for the transition from c-VATS to r-VATS. The utility and advantages of triangular trocar configuration for r-VATS require further refinement and research before it can be routinely adopted in clinical practice. Trial registration Retrospectively registered.
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Affiliation(s)
- Vu Huu Vinh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam.
| | - Nguyen Viet Dang Quang
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Dang Dinh Minh Thanh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Truong Van Le Phong
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
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12
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Andreetti C, Peritore V, Ibrahim M, Gagliardi A, Argento G, Maurizi G, Teodonio L, Serra N, Rendina EA, Santini M, Fiorelli A. Subxifoid versus transthoracic thoracoscopic lobectomy: Results of a retrospective analysis before and after matching analysis. Thorac Cancer 2021; 12:1279-1290. [PMID: 33689213 PMCID: PMC8088929 DOI: 10.1111/1759-7714.13778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background Here, we report our initial experience with subxifoid video‐assisted thoracoscopic surgery (SVATS) lobectomy for the management of primary lung cancer, and compared the outcomes of SVATS with those of conventional transthoracic VATS (CVATS) lobectomies to validate its feasibility and usefulness. Methods The clinical data of consecutive patients undergoing VATS lobectomy via SVATS or CVATS for lung cancer were retrospectively compared. The endpoints were to evaluate the statistical differences in surgical results, postoperative pain (measured with visual analog scale [VAS] scores at 8 hours, Day 1, Day 2, Day 3, at discharge, one month and three months after surgery) and paresthesia (measured at one‐ month, and three months after surgery). The two groups were compared before and after matching analysis. Results Our study population included 223 patients: 84 in the SVATS and 139 in the CVATS group. The two groups were not comparable for sex (P = 0.001), preoperative comorbidity as cardiopathy (P = 0.007), BMI value (P = 0.003), left‐sided procedure (P = 0.04), tumor stage (P = 0.04), and tumor size (P = 0.002). These differences were overcome by propensity score matching (PSM) analysis that yielded two well‐matched groups which included 61 patients in each group. Surgical outcomes including blood loss, hospital stay and complications were similar before and after matching analysis, but SVATS compared to CVATS was associated with longer operative time before (159 ± 13 vs. 126 ± 6.3, P < 0.0001), and after matching analysis (161 ± 23 vs. 119 ± 8.3; P < 0.0001) and significant reduction of postoperative pain during the different time‐points (P < 0.001), and paresthesia at one (P = 0.001), and three months (P < 0.0001). Conclusions SVATS lobectomy is a feasible and safe strategy with surgical outcomes similar to CVATS lobectomy but with less postoperative pain and paresthesia. Key points Significant findings of the study Subxifoid thoracoscopic lobectomy is a feasible and safe procedure, with potential benefits in terms of postoperative pain and paresthesia compared to conventional thoracoscopic lobectomy Our results showed that surgical outcomes including blood loss, hospital stay, morbidity and mortality are similar but subxifoid thoracoscopy was associated with significant reduction of postoperative pain and paresthesia.
What this study adds Subxifoid thoracoscopy is a safe procedure; compared to conventional transthoracic thoracoscopy, it avoids intercostal incisions, and spares nerve trauma, resulting in a reduction of postoperative pain and paresthesia.
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Affiliation(s)
- Claudio Andreetti
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Valentina Peritore
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Antonio Gagliardi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giacomo Argento
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giulio Maurizi
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Leonardo Teodonio
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Nicola Serra
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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13
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Li M, Xu L, Li L, Dai Q, Xu D. The Early Perioperative Outcomes of Subxiphoid Approach Versus Lateral Intercostal Approach Thoracoscopic Thymectomy for Thymic Tumors: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:256-264. [PMID: 33661028 DOI: 10.1089/lap.2021.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: To systematically evaluate the early perioperative outcomes regarding the safety and efficacy of subxiphoid thoracoscopic thymectomy (STT) versus lateral intercostal thoracoscopic thymectomy (LITT) for patients with thymic tumors. Methods: A thorough literature search of the following online databases was performed: Web of Science, PubMed, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.gov. Original research articles published before December 30, 2020, that compared STT with LITT were included. Meta-analysis was performed for early perioperative outcomes, including blood loss, pain score, duration of hospital stay, operative time, chest tube drainage time, and incidence of postoperative complications. Results: Six studies that included 604 patients were finally selected for our analysis, with 296 cases of STT and 308 cases of LITT. Our results showed that compared with LITT, STT was associated with less blood loss (standardized mean difference = -0.81, 95% confidence interval [CI] = -1.49 to -0.14, P = .02), a lower pain score (weighted mean difference [WMD] = -2.55, 95% CI = -3.52 to -1.59; P < .00001), and a shorter hospital stay (WMD = -1.37, 95% CI = -2.37 to -0.36; P = .008), whereas there were no significant differences with regard to the operative time (WMD = -10.04, 95% CI = -22.29 to 2.21, P = .11), chest tube drainage time (WMD = -0.58, 95% CI = -1.17 to 0.02, P = .06), and the incidence of postoperative complications (odds ratio = 0.75, 95% CI = 0.39 to 1.44, P = .38). Conclusions: The current analysis suggests that STT is superior to LITT with respect to the early perioperative outcomes, and STT is a safe and effective surgical method for patients with thymic tumors.
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Affiliation(s)
- Meng Li
- Department of Thoracic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Linhao Xu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Li Li
- Kangda College, Nanjing Medical University, Lianyungang, China
| | - Qin Dai
- Department of Thoracic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Dandan Xu
- Department of Oncology, The Second People's Hospital of Lianyungang, Lianyungang, China
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14
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Xu H, Liu D, Li Y, Yang L, Wang F, Wang W, Zhang L. The Outcomes of Subxiphoid Thoracoscopic Versus Video-Assisted Thoracic Surgery for Thymic Diseases. J Laparoendosc Adv Surg Tech A 2020; 30:508-513. [PMID: 32004095 DOI: 10.1089/lap.2019.0734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hao Xu
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Dazhong Liu
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Yi Li
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Lei Yang
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Fei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China
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15
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He J, Yang H, He J, Li S. Electromagnetic navigation bronchoscopy fluorescence localization and VATS subxiphoid bilateral wedge resection under non-intubated anesthesia. J Thorac Dis 2019; 11:3186-3190. [PMID: 31463149 DOI: 10.21037/jtd.2019.06.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Shuben Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
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16
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Abdellateef A, Ali JM, Jiang G, Aresu G, Jiang L. Tips and tricks for success in subxiphoid video-assisted thoracic surgery. J Thorac Dis 2019; 11:292-301. [PMID: 30863607 DOI: 10.21037/jtd.2018.12.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The subxiphoid approach to video-assisted thoracic surgery (VATS) has been introduced as an alternative to intercostal VATS. There is some evidence that avoiding intercostal incision and instrumentation leads to reduced pain and facilitates early mobilisation and enhanced recovery. Access of the pleural cavities and anterior mediastinal space through a subxiphoid incision presents some challenges, particularly when accessing posterior pulmonary lesions. With increasing experience, a large range of thoracic surgical operations performed through the subxiphoid approach have been reported including anatomical segmentectomies, thymectomies. Another attraction is that bilateral procedures can be performed through a single incision. The experience of several surgeons passing through the learning curve of subxiphoid VATS surgery has resulted in overcoming many of the early challenges faced. In this paper, a series of tips and tricks are presented to enable surgeons considering adopting this technique into their practice to do so safely and with an appreciation of the difficulties that they may face.
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Affiliation(s)
- Amr Abdellateef
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Mansoura University Hospital, Mansoura School of Medicine, Mansoura University, Mansoura, Egypt
| | - Jason M Ali
- Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Giuseppe Aresu
- Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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