Robot-assisted thoracic surgery for complex procedures
Journal
Journal of Thoracic Disease
Journal Volume
9
Journal Issue
9
Pages
3105-3113
Date Issued
2017
Abstract
Background: As an option for minimally invasive thoracic surgery, robot-assisted thoracic surgery (RATS) has shown comparable perioperative outcomes to those achieved by traditional video-assisted thoracic surgery (VATS). It is unknown whether RATS might have any potential benefits in more complex thoracic surgical procedures, which usually require open surgery instead of VATS. The current study presents a preliminary result regarding the use of RATS in complex thoracic operations in an attempt to address this unresolved question. Methods: Data from a prospectively collected and maintained surgical database were collected on patients who underwent RATS between February 2012 and August 2014. We defined complex RATS as those operations involving difficult dissections, complex sutures or excision of very large tumors (>8 cm) which would have required open surgery in our hospital before the introduction of RATS. The characteristics and peri-operative outcomes of patients receiving complex RATS were reviewed. Results: Of the 120 patients undergoing RATS, 30 of them were classified as having undergone complex RATS, 21 to remove lung tumors and 9 to remove mediastinal tumors. The indications for complex RATS included 21 difficult dissections, 10 complex sutures, and 7 very large tumors (8 patients had two indications). There are three conversions to thoracotomy for pulmonary arterial bleeding. There was one mortality resulted from post-pneumonectomy pulmonary hypertension and sepsis. Patients with difficult dissection had longer operative time and hospital stay, and more bleeding and postoperative morbidity. Conclusions: RATS for complex thoracic procedures is feasible, especially for complex suturing and excision of very large mediastinal tumors, but more attention is needed for patients needing difficult dissections. Advanced preparation for conversion is necessary during this difficult operation. ? Journal of Thoracic Disease.
SDGs
Other Subjects
adult; aged; Article; bronchoplasty; cancer staging; carcinoma; chemoradiotherapy; complex robot assisted thoracic surgery; controlled study; feasibility study; female; follow up; human; length of stay; lobectomy; lung metastasis; lung resection; lung tumor; lymph node dissection; major clinical study; male; mediastinum tumor; middle aged; minimally invasive surgery; morbidity; operation duration; outcome assessment; Pancoast tumor; patient coding; patient safety; pleomorphic carcinoma; postoperative complication; primary tumor; prospective study; pulmonary arterial bleeding; pulmonary hypertension; pulmonary vascular disease; robot assisted surgery; sepsis; sleeve lobectomy; surgical approach; surgical mortality; suture; thoracotomy; thorax surgery; treatment indication; tumor volume; very elderly; wedge resection; young adult
Publisher
AME Publishing Company
Type
journal article