1
|
Jin W, Zheng L, Fan X, Wang H, Wang Q, Yang C. A comparison of three-port and four-port Da Vinci robot-assisted thoracoscopic surgery for lung cancer: a retrospective study. J Cardiothorac Surg 2024; 19:377. [PMID: 38926727 PMCID: PMC11201359 DOI: 10.1186/s13019-024-02920-7] [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: 04/21/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND At present, research comparing the short-term postoperative outcomes of anatomical resection in lung cancer under different ports of da Vinci robot-assisted surgery is insufficient. This report aimed to compare the outcomes of three-port and four-port da Vinci robot-assisted thoracoscopic surgery for radical dissection of lung cancer. METHODS 171 consecutive patients who presented to our hospital from January 2020 to October 2021 with non-small cell lung cancer and treated with da Vinci robot-assisted thoracoscopic surgery for radical resection of lung cancer were retrospectively collected and divided into the three-port group (n = 97) and the four-port group (n = 74). The general clinical data, perioperative data and life quality were individually compared between the two groups. RESULTS All the 171 patients successfully underwent surgeries. Compared to the four-port group, the three-port group had comparable baseline characteristics in terms of age, sex, tumor location, tumor size, history of chronic disease, pathological type, and pathological staging. The three-port group also had shorter operation time, less intraoperative blood loss, lower chest tube drainage volume, shorter postoperative hospitalization stay durations, but showed no statistically significant difference (P > 0.05). Postoperative 24, 48 and 72 h visual analogue scale pain scores were lower in the three-port group (p < 0.001). No significant difference was observed between the two groups in the hospitalization costs (P = 0.664), number or stations of total lymph node dissected (p > 0.05) and postoperative respiratory complications (P > 0.05). CONCLUSIONS The three-port robot-assisted thoracoscopic surgery is safe and effective and took better outcomes than the four-port robot-assisted thoracoscopic surgery in non-small cell lung cancer.
Collapse
Affiliation(s)
- Wenjian Jin
- Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Liang Zheng
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Xiao Fan
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Hui Wang
- Department of Pathology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Qianyun Wang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Chen Yang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China.
| |
Collapse
|
2
|
Mokhtari L, Hosseinzadeh F, Nourazarian A. Biochemical implications of robotic surgery: a new frontier in the operating room. J Robot Surg 2024; 18:91. [PMID: 38401027 DOI: 10.1007/s11701-024-01861-6] [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: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.
Collapse
Affiliation(s)
- Leila Mokhtari
- Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran.
| |
Collapse
|
3
|
Luo J, Mei Z, Lin S, Xing X, Qian X, Lin H. Integrative pan-cancer analysis reveals the importance of PAQR family in lung cancer. J Cancer Res Clin Oncol 2023; 149:10149-10160. [PMID: 37266662 DOI: 10.1007/s00432-023-04922-9] [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: 04/17/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The progestin and adipoQ receptors (PAQRs) family contains 11 genes involved in the regulation of metabolism and cancer development. However, a comprehensive understanding of the role of PAQRs in cancer remains largely scarce, and the associations between their expression levels and immune signatures also need to be researched. METHODS Here, we applied pan-cancer analysis to explore the associations between PAQRs expression and survival, tumor microenvironment (TME), and drug sensitivity from the UCSC Xena and CellMiner databases. Besides, we further studied the expression, survival and somatic mutations of PAQRs in lung cancer (LC) from TCGA database. RESULTS The results showed that PAQRs had significant heterogeneity with some upregulation and some downregulation in most tumors. Specifically, compared with PAQR3/5/6/9 and MMD2, ADIPOR1/2, PAQR4/7/8 and MMD had higher levels of average expression in all tumor types. PAQRs expression was greatly correlated with survival, immune subtypes, TME, and drug sensitivity. Furthermore, this research concentrated on analyzing the relationship of PAQRs expression with LC prognosis, and proved that ADIPOR2, PAQR4/9 and MMD were independent prognostic factors for LC patients. Finally, based on somatic mutation data, the genetic mutations in LC patients were majorly missense mutations, and TP53 and TTN had the top two highest mutation frequencies. CONCLUSION Collectively, PAQRs may serve as robust biomarkers to predict the prognosis and guide immunotherapy of tumors, especially LC, which enables novel ways for improving cancer treatment.
Collapse
Affiliation(s)
- Jingru Luo
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China
| | - Zhenxin Mei
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China
| | - Shu Lin
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China
| | - Xin Xing
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China
| | - Xiaoying Qian
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China.
| | - Haifeng Lin
- Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, No. 368, Yehai Avenue, Longhua District, Haikou, 570100, Hainan, China.
| |
Collapse
|
4
|
Gonzalez-Rivas D, Manolache V, Bosinceanu ML, Gallego-Poveda J, Garcia-Perez A, de la Torre M, Turna A, Motas N. Uniportal pure robotic-assisted thoracic surgery-technical aspects, tips and tricks. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:362. [PMID: 37675313 PMCID: PMC10477623 DOI: 10.21037/atm-22-1866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/06/2022] [Indexed: 09/08/2023]
Abstract
The uniportal access for robotic thoracic surgery presents itself as a natural evolution of minimally invasive thoracic surgery (MITS). It was developed by surgeons who pioneered the uniportal video-assisted thoracic surgery (U-VATS) in all its aspects following the same principles of a single incision by using robotic technology. The robotic surgery was initially started as a hybrid procedure with the use of thoracoscopic staplers by the assistant. However, due to the evolution of robotic modern platforms, the staplers can be nowadays controlled by the main surgeon from the console. The pure uniportal robotic-assisted thoracic surgery (U-RATS) is defined as the robotic thoracic surgery performed through a single intercostal (ic) incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers. There are presented the advantages, difficulties, the general aspects and specific considerations for U-RATS. For safety reasons, the authors recommend the transition from multiportal-RATS through biportal-RATS to U-RATS. The use of robotic dissection and staplers through a single incision and the rapid undocking with easy emergent conversion when needed (either to U-VATS or to thoracotomy) are safety advantages over multi-port RATS that cannot be overlooked, offering great comfort to the surgeon and quick and smooth recovery to the patient.
Collapse
Affiliation(s)
- Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
- Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | - Veronica Manolache
- Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Mugurel Liviu Bosinceanu
- Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | | | - Alejandro Garcia-Perez
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Mercedes de la Torre
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Natalia Motas
- Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Department of Thoracic Surgery, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, Bucharest, Romania
| |
Collapse
|
5
|
Moonsamy P, Park B. Uniportal Robotic Lung Resection Techniques. Thorac Surg Clin 2023; 33:283-289. [PMID: 37414484 DOI: 10.1016/j.thorsurg.2023.04.006] [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: 07/08/2023]
Abstract
Uniportal video-assisted thoracic surgical (U-VATS) and telerobotic techniques have become widely adopted strategies for lung resection and represent a natural progression born of advancing technologic innovation and decades of expanding clinical experience. Combining the best that each approach offers may be the next logical step in the evolution of minimally invasive thoracic surgery. Two parallel efforts are underway: one that combines the traditional U-VATS incision with a multi-arm telerobotic platform and one that utilizes a new single-arm device. Feasibility and refinement of surgical technique will need to be achieved before any conclusions about efficacy can be drawn.
Collapse
Affiliation(s)
- Philicia Moonsamy
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Austen 7, Boston, MA 02114, USA
| | - Bernard Park
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-879, New York, NY 10065, USA.
| |
Collapse
|
6
|
Gonzalez-Rivas D, Bosinceanu M, Manolache V, Gallego-Poveda J, Garcia A, Paradela M, Dunning J, Bale M, Motas N. Uniportal fully robotic-assisted major pulmonary resections. Ann Cardiothorac Surg 2023; 12:52-61. [PMID: 36793991 PMCID: PMC9922773 DOI: 10.21037/acs-2022-urats-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023]
Abstract
Robotic-assisted thoracoscopic surgery (RATS) has proven advantages over that of conventional thoracic surgery, primarily by offering a three-dimensional view and excellent maneuverability, and by providing great ergonomic comfort to the surgeon. The instrumentation specifically offers seven degrees of freedom, allowing for safe, yet complex dissections and radical lymphadenectomies. However, the robotic platform was initially designed with four robotic arms in mind, and therefore four to five incisions were needed for most thoracic approaches. The uniportal video-assisted thoracoscopic surgery (UVATS) approach, the philosophical predecessor to the uniportal robotic-assisted thoracoscopic surgery (URATS) approach, evolved very quickly with the help of the latest technologies during the last decade. Since the first cases of UVATS in 2010, we have improved upon the technique, such that we are now able to do increasingly more complex cases. This is due to the acquired experience, specifically designed instruments, better high-definition cameras and more angulated staplers. In our efforts to improve and adapt robotic surgery to the uniportal approach, we utilized the initial available platforms (Davinci Si and X) to test the feasibility of this approach, in terms of safety and possibilities. The latest platform, the Da Vinci Xi, due to the configuration of its arms, did indeed allow for us to reduce the number of incisions to two initially and finally to one. We hence decided to fully adapt the Da Vinci Xi® to allow for the URATS approach routinely, and performed the first fully robotic anatomic resections in the world in September 2021, in Coruña, Spain. We define pure or fully robotic URATS as robotic thoracic surgery performed by a single intercostal incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers.
Collapse
Affiliation(s)
- Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain;,Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania;,Department of Cardio-Thoracic Surgery, Lusiadas Hospital, Lisbon, Portugal;,Department of Thoracic Surgery, Yashoda Hospital, Hyderabad, India
| | | | - Veronica Manolache
- Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania;,University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | | | - Alejandro Garcia
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Marina Paradela
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Manjunath Bale
- Department of Thoracic Surgery, Yashoda Hospital, Hyderabad, India
| | - Natalia Motas
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania;,Department of Thoracic Surgery, Institute of Oncology “Prof.Dr. Al.Trestioreanu” Bucharest, Romania
| |
Collapse
|
7
|
E H, Yang C, Wu J, Wu J, Xu L, Wang T, Zhang L, Jiang G, Zhu Y, Chen C, Zhao D. Hybrid uniportal robotic-assisted thoracoscopic surgery using video-assisted thoracoscopic surgery staplers: technical aspects and results. Ann Cardiothorac Surg 2023; 12:34-40. [PMID: 36793988 PMCID: PMC9922775 DOI: 10.21037/acs-2022-urats-140] [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: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Background The clinical efficacy of robot-assisted thoracic surgeries has been explored by numerous recent studies. Nonetheless, since current standard robotic systems (da Vinci Xi system) were intended for multiportal surgical processes and robotic staplers were still unavailable in the developing world, obstacles still remain concerning the feasibility of uniportal robotic surgeries. Methods A hybrid uniportal robotic-assisted thoracoscopic surgery (RATS) modality utilizing video-assisted thoracoscopic surgery (VATS) staplers was investigated in Shanghai Pulmonary Hospital. Clinicopathological characteristics and perioperative outcomes concerning patients receiving hybrid uniportal RATS between August 2022 and September 2022 were collected. Results A total of 40 patients were included in this study. Most of the patients (23/40, 57.5%) received hybrid uniportal RATS lobectomies. One conversion from uniportal RATS to biportal process was encountered due to extensive adhesions discovered intraoperatively. The median procedural duration was 76 min [interquartile range (IQR), 61-99 min], and the median blood loss volume was 50 mL (IQR, 50-50 mL). A median stay length of three days (IQR, 2-4 days) was recorded. Eleven patients (27.5%) developed Clavien-Dindo grade I-II postoperative complications, while no grade III-IV complications were observed. Aside from this, none of the patients were readmitted or died within 30 days post-surgery. Conclusions The feasibility of hybrid uniportal RATS procedures using VATS staplers has been preliminarily validated. For early-stage non-small cell lung cancer patients, such a procedure might clinical efficacy comparable to that of uniportal RATS utilizing robotic staplers.
Collapse
Affiliation(s)
- Haoran E
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tao Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
8
|
Port Placement Variations for Robotic Lung Resection: Focusing on Their History, Conventional Look-Up-View and Horizontal Open-Thoracotomy-View Techniques, and More. J Pers Med 2023; 13:jpm13020230. [PMID: 36836464 PMCID: PMC9966785 DOI: 10.3390/jpm13020230] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
This is a narrative review that summarizes the variations in approaches and port placements used for performing robotic lung resections on the da Vinci Surgical Platforms. Currently, the four-arm, look-up-view method, in which the intrathoracic cranial side is viewed from the caudal side, is considered the mainstream approach worldwide. Several variations were devised from this conventional technique, including the so-called horizontal open-thoracotomy-view techniques in which the intrathoracic craniocaudal axis is aligned with the horizontal direction of the console monitor, and fewer port and incision techniques. In September 2022, 166 reports were surveyed using a PubMed English literature search, and this review finally included 30 reports describing the approaches. We categorized the variations into four-phase groups considering advent histories: (I) early era, three-arm technique with utility incisions; (II) four-arm, total port technique without robotic staplers; (III) four-arm technique using robotic staplers; (IV) maximizing the functional features of the Xi, significant alterations in viewing directions, and reducing ports, including the ultimate uniport technique. To comprehensibly visualize these variations for practical use, we created elaborate illustrations based on the literature. The familiarity of thoracic surgeons with the variations and characteristics allows them to choose the optimal procedure that best suits each patient and their preferences.
Collapse
|
9
|
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.
Collapse
|
10
|
Mercadante E, Martucci N, De Luca G, La Rocca A, La Manna C. Early experience with uniportal robotic thoracic surgery lobectomy. Front Surg 2022; 9:1005860. [PMID: 36329983 PMCID: PMC9624124 DOI: 10.3389/fsurg.2022.1005860] [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: 07/28/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Invasiveness is considered one of the cornerstones of every field of surgery, and video-assisted thoracoscopic (VATS) approaches are now routinely used worldwide to perform pulmonary resections. Recently, robotic-assisted thoracic surgery (RATS) has become the preferred technique in many centers; it is routinely performed using three or four ports with at least one service incision, contrasting with the real concept of invasiveness, especially when compared to uniportal VATS (U-VATS). Hereby, we present our early experience with uniportal RATS (U-RATS) pulmonary resections for early-stage lung cancer. Technical details of surgical steps are accurately described and commented on. Results Twenty-four consecutive patients with lung cancer underwent U-RATS anatomical pulmonary resections at our institute. All procedures were completed with the uniportal approach. The mean operative time was 210 min (range 120–350); in the last 10 cases, the operative time was significantly reduced (180 min) compared to the first 10 cases (232 min) (p < 0.02), showing a very fast learning curve. The postoperative pain score was comparable to that for U-VATS and was constantly low. Conclusions U-RATS is a safe and feasible technique, combining the advantages of U-VATS with the well-known advantages of robotic surgery.
Collapse
Affiliation(s)
- Edoardo Mercadante
- Thoracic Surgery Unit - Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy,Correspondence: Edoardo Mercadante
| | - Nicola Martucci
- Thoracic Surgery Unit - Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Giuseppe De Luca
- Thoracic Surgery Unit - Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Antonello La Rocca
- Thoracic Surgery Unit - Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Carmine La Manna
- Thoracic Surgery Unit - Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| |
Collapse
|
11
|
Gonzalez-Rivas D, Bosinceanu M, Motas N, Manolache V. Uniportal Robotic-Assisted Thoracic Surgery for Lung Resections. Eur J Cardiothorac Surg 2022; 62:6661347. [PMID: 35951763 DOI: 10.1093/ejcts/ezac410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/13/2022] Open
Abstract
Pure Uniportal Robotic-Assisted Thoracic Surgery (U-RATS) is the robotic thoracic surgery performed through a single intercostal incision, without rib spreading, using the robotic camera, robotic dissecting instruments, and robotic staplers. Compared to multiport, U-RATS simplifies the management of possible intraoperative bleeding, mainly due to rapid undocking and the necessary uniportal experience of the surgeon. U-RATS offers a possible uniportal robotic surgical management of lung resections, with comfort for surgeons and quick and smooth recovery for patients.
Collapse
Affiliation(s)
- Diego Gonzalez-Rivas
- Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain.,Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | - Mugurel Bosinceanu
- Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | - Natalia Motas
- Thoracic Surgery, Institute of Oncology "Prof.Dr. Al.Trestioreanu, " Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | - Veronica Manolache
- Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| |
Collapse
|
12
|
Tao Z, Kuai X, Wang G, Liu S, Liu K, Zhang H, Xia S, Zhu H. Combination of chemotherapy and immune checkpoint therapy by the immunoconjugates-based nanocomplexes synergistically improves therapeutic efficacy in SCLC. Drug Deliv 2022; 29:1571-1581. [PMID: 35612299 DOI: 10.1080/10717544.2022.2039803] [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: 11/03/2022] Open
Abstract
Although the etoposide and carboplatin (EP) combination strategy has been the first-line chemotherapy, patients with extensive-stage disease small-cell lung cancer (SCLC) still have poor survival outcomes. Our retrospective analysis revealed that 46 patients with SCLC only achieved medium overall survival (OS) of 11.6 months after treated by EP. Recently, it was demonstrated that combination therapy of PD1/PD-L1 immune checkpoint blocker and EP could significantly improve the OS of SCLC patients. However, the serious treatment-related toxicity leaded to a high rate of treatment-discontinuation or even death. In the present study, we have developed a novel TPP1-conjugated nanocomplex, abbreviated as TPP1NP-EP, which was co-loaded with carboplatin (CBP) and etoposide (VP16). The TPP1 was a PD-L1 targeting peptide and conjugated on the surface of nanocomplex by a matrix metalloproteinase (MMP-2/9)-cleavable peptide linker sequence PLGLAG. For dual-loading of CBP and VP16, the CBP was chemically conjugated with poly(ethylene glycol) (PEG)-poly(caprolactone) (PCL) by pH-sensitive hydrazone bond and the VP16 was physically encapsulated by emulsion-solvent evaporation method. In vitro and in vivo experiments demonstrated an excellent anti-tumor effect of TPP1NP-EP on SCLC and improved safety. In conclusion, the present study has provided a promising strategy for treatment of malignant SCLC.
Collapse
Affiliation(s)
- Zhang Tao
- Department of Respiratory Medicine, Yancheng Hospital of traditional Chinese Medicine, Yancheng, Jiangsu Province, PR China.,Department of Respiratory Medicine, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Xingwang Kuai
- Department of Pathology, Medical School of Nantong University, Nantong, Jiangsu Province, PR China
| | - Guangwei Wang
- Department of Orthopedic surgery, Yancheng Hospital of traditional Chinese medicine, Jiangsu Province, PR China.,Department of Orthopedic surgery, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Sanfeng Liu
- Department of Respiratory Medicine, Yancheng Hospital of traditional Chinese Medicine, Yancheng, Jiangsu Province, PR China.,Department of Respiratory Medicine, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Kai Liu
- Department of Respiratory Medicine, Yancheng Hospital of traditional Chinese Medicine, Yancheng, Jiangsu Province, PR China.,Department of Respiratory Medicine, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Heng Zhang
- Department of Respiratory Medicine, Yancheng Hospital of traditional Chinese Medicine, Yancheng, Jiangsu Province, PR China.,Department of Respiratory Medicine, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Shujing Xia
- Department of Gastroenterology, Yancheng Hospital of Traditional Chinese Medicine, Jiangsu Province, PR China.,Department of Gastroenterology, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, Jiangsu Province, PR China
| | - Hua Zhu
- Department of Gastroenterology, Yancheng Third People's Hospital, Jiangsu Province, PR China
| |
Collapse
|
13
|
Parini S, Massera F, Papalia E, Baietto G, Bora G, Rena O. Port Placement Strategies for Robotic Pulmonary Lobectomy: A Narrative Review. J Clin Med 2022; 11:jcm11092612. [PMID: 35566741 PMCID: PMC9103382 DOI: 10.3390/jcm11092612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Despite the use of robotics becoming increasingly popular among thoracic surgeons worldwide, there remains debate over the best robotic approach for lung resections. In this paper, we delineated the main port placement strategies and discussed their advantages and disadvantages. Methods: A PubMed literature review was performed using key phrases such as “robotic lobectomy technique”, “RATS lobectomy”, and “port placement robotic lobectomy”. After the final review, 22 articles were included as references, of which 10 described common robotic port mapping techniques. Results: Several port strategies for robot-assisted pulmonary lobectomies have been proposed and described in the literature, each showing its own limitations and advantages. Conclusions: New robotic surgeons may choose their port strategy according to personal preference and previous surgical experience, especially regarding open or VATS resections. Robust data comparing different port placements in robotic surgery are lacking. Further research should be directed toward comparisons of clinical outcomes with different robotic approaches.
Collapse
Affiliation(s)
- Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
- Correspondence:
| | - Fabio Massera
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Esther Papalia
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Guido Baietto
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Giulia Bora
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| |
Collapse
|