Preferences for treatment of lobectomy in Chinese lung cancer patients: video-assisted thoracoscopic surgery or open thoracotomy?

A Concentric Tube Robot System for Rigid Bronchoscopy: A Feasibility Study on Central Airway Obstruction Removal

New robotic systems have recently emerged to assist with peripheral lung access, but a robotic system for rigid bronchoscopy has yet to be developed. We describe a new robotic system that can deliver thin robotic manipulators through the ports of standard rigid bronchoscopes. The manipulators bend and elongate to provide maneuverability of surgical tools at the endoscope tip, without endoscope motion. We describe an initial feasibility study on the use of this system to bronchoscopically treat a central airway obstruction (CAO). CAO is prevalent and can be life-threatening in patients with large tumors, and conventional rigid bronchoscopic treatments place patients at risk of complications including broken teeth, neck trauma and damage to oropharyngeal structures due to significant forces induced by bronchoscope tilting and manipulation. In this study, we used an ex vivo ovine airway model to demonstrate the ability of a physician using the robotic system to efficiently remove tissue and restore the airway. Pre- and post-operative CT scans showed that the robot was able to reduce the degree of airway obstruction stenosis from 75 to 14% on average for five CAO resections performed in an ex vivo animal model. Using cadaver experiments, we demonstrated the potential of the robotic system to substantially reduce the intraoperative forces applied to the patient's head and neck (from 80.6 to 4.1 N). These preliminary results illustrate that CAO removal is feasible with our new rigid bronchoscopy robot system, and that this approach has the potential to reduce forces applied to the patient due to bronchoscope angulation, and thereby reduce the risk of complications encountered during CAO surgery.

A systematic review of questionnaires about patient's values and preferences in clinical practice guidelines

OBJECTIVE

We conducted a systematic review to evaluate questionnaires about patient's values and preferences to provide information on the most appropriate questionnaires to be used when developing clinical practice guidelines.

METHODS

A systematic literature search of the Cochrane Library, MEDLINE, Embase, Web of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, and the Wanfang Database was performed to identify studies on questionnaires evaluating patient's values and preferences. The articles that used fully structured questionnaires or scales with standardized questions and answer options were included. We assessed the questionnaires' construction and content with a psychometric methodology and summarized the domains and items about patient's preferences and values.

RESULTS

A total of 7,008 records were retrieved by the search strategy and scanned, and 20 articles were finally included. Of these, 10 (50%) articles described the process of item generation and only four questionnaires (20%, 4/20) mentioned the pilot testing. Regarding "validity", seven questionnaires (35%, 7/20) assessed validity and only one (5%, 1/20) questionnaire assessed internal consistency, with Cornbrash's α values of 0.74-0.87. For "acceptability", the time to complete the questionnaires ranged from 10 to 30 minutes and only nine studies (45%, 9/20) reported the response rates. In addition, the results of domains and items about patient's preferences and values showed that the "effectiveness" domain was the most considered item in the patient's value questionnaire followed by "safety", "prognosis", and others, whereas the least considered domain was "physician's experience".

CONCLUSION

Only a few studies have developed questionnaires with rigorous psychometric methods to measure patient's preferences and values. Currently, still there is no valid or reliable questionnaire for patient's preferences and values for use when developing clinical practice guidelines. Further study should be conducted to develop standardized instruments to measure patient's preferences and values. This study provides the domains and items that may be used in formulating questionnaires about patient's preferences and values.

Two-portal versus three-port video-assist thoracoscopic surgery for early stage nonsmall cell lung cancer: A retrospective study

This study was conducted to compare the perioperative outcomes of two-portal and three-port video-assist thoracoscopic surgery (VATS) for early stage nonsmall cell lung cancer.In this retrospective analysis, 279 cases of two-port VATS with a single utility port and 152 cases of three-port VATS performed by our department from October 2010 to December 2014 were collected. The operative time, volume of intraoperative blood loss, number of dissected lymph nodes, volume of postoperative pleural drainage, postoperative extubation time, and duration of postoperative hospitalization were compared between these 2 groups.No statistically significant differences on the operative time, volume of postoperative bleed, and the number of dissected lymph nodes was noted between two-port and three-port video-assist thoracoscopic surgery. Less postoperative pleural drainage, shorter extubation time, and postoperative hospitalization were observed in the two-port VATS group when compared with those of three-port VTAS groupTwo-port VATS decreased operative postoperative pleural drainage and resulted in shorter extubation time and postoperative hospitalization compared with three-port VATS. Two-port VATS is a safe and feasible approach for early stage nonsmall cell lung cancer.

Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer: a system review and meta-analysis

The aim of this meta-analysis is to compare the perioperative morbidity and mortality outcomes of robotic-assisted thoracic surgery (RATS) with open thoracic surgery (OTS) for patients with lung cancer. We searched articles indexed in the Pubmed and Sciencedirect published as of July 2015 that met our predefined criteria. A meta-analysis was performed by combining the results of reported incidences of perioperative morbidity and mortality. The relative risk (RR) was used as a summary statistic. Five eligible articles with 2433 subjects were considered in the analysis (5 articles for morbidity, while 3 articles for mortality). Overall, pooled analysis indicated that perioperative morbidity and mortality rate was significantly lower among patients who underwent RATS than patients who underwent OTS (for morbidity: RR, 0.83; 95% CI, 0.75 to 0.92; P<0.01; for mortality: RR, 0.14; 95% CI, 0.03 to 0.59; P=0.007). No evidence of publication bias was observed. In conclusion, this meta-analysis showed that RATS resulted in significantly lower perioperative morbidity and mortality rate compared with OTS cases. Thus, we suggest RATS be an appropriate alternative to OTS for lung cancer resection. RATS should be studied further in selected centers and compared with OTS in a randomized fashion to better define its potential advantages and disadvantages.