ObjectiveTo investigate the safety and efficacy of robot-assisted pulmonary lobectomy using da Vinci S System, and explore its advantages in minimally invasive surgery. MethodsFrom May 2009 to May 2013, 12 patients with suspected non-small cell lung cancer (NSCLC) underwent robot-assisted lobectomy using da Vinci S System in Shanghai Chest Hospital. There were 6 male and 6 female patients with their age of 40-61 (52±8) years. Robotic instruments were used through a 12-mm observation port, two 8-mm thoracoscopic ports and a 12 to 40 mm utility incision without rib spreading. Perioperative data of the patients were collected and analyzed. ResultsAll the 12 patients successfully received surgical resection. All types of lobectomy were performed, and all the procedures were radical resection. Each patient received 4 to 9 (5±1) stations of lymph node dissection. None of the patients underwent conversion to thoracotomy. There was no perioperative mortality or morbidity in this group. Chest drainage duration was 3-11 (8±7) days. Length of hospital stay was 6 to 18 (14±8) days. Operation time was 60 to 280 (185±78) minutes. Intraoperative blood loss was 20 to 200 (108±71) ml. There was no perioperative blood transfusion. ConclusionsRobot-assisted lobectomy is initially proven a safe and effective procedure with enhanced visualization and better dexterity and stability than video-assisted thoracopscopic surgery. Thus surgical indications for robot-assisted lobectomy can be widened. Robot-assisted lobectomy is an important choice in the new age of minimally invasive thoracic surgery.
ObjectivesTo investigate the safety and efficacy of robot-assisted surgery for mediastinal tumor. MethodsWe respectively analyzed the clinical data of 47 patients with clinical diagnosis of mediastinal tumor undergoing robot-assisted surgery in our hospital from May 2009 to March 2015. There were 29 males and 18 females at age of 48 (20-78) years. Robotic instruments were used through two 8 mm thoracoscopic ports and camera placed through a 12 mm observation port, without any additional utility incision. ResultsAll 47 surgeries were accomplished successfully. The operative time was 73±36 minutes. The blood loss was 48±15 ml. There was only one conversion due to bleeding during the operation. No perioperative mortality or morbidity occurred. There was no perioperative transfusion. Learning curve showed operative time shortened sharply as the procedures increased. After 20 cases of procedure, operative time was stabilized as the learning curve established. The equation is y(min)=-20.41ln(x)+119.43, R2=0.312, P<0.01. ConclusionRobot-assisted surgery for mediastinal tumor are initially proved safe and feasible with great perspective in the new age of minimally invasive thoracic surgery.
ObjectiveTo estimate postoperative pain and use of analgesic of patients who underwent video-assisted thoracoscopic surgery(VATS) or robotic assisted thoracoscopic surgery(RATS). MethodsFrom October 2014 through August 2015, 339 patients were treated by surgery in Shanghai Chest Hospital. Among them, 116 patients with intrathoracic lesions who underwent RATS with the da Vinci? Surgical System were as a RATS group with 51 males and 65 females at age of 52.59±11.49 years. Another 223 patients by VATS were as a VATS group with 93 males and 130 females at age of 58.00±10.56 years. We recorded the data of the VAS score and use analgesic of the patients after surgery. ResultsThere was a significant difference in VAS score between the RATS group and the VATS group(3.01±0.18 vs. 5.19±0.14, P<0.05). Astatistical difference of analgesic use between RATS and VATS was also found(1.09±0.12 vs. 1.77±0.10, P<0.05). ConclusionCompared with VATS, the postoperative pain of the patients who underwent RATS is lighter. And the use of analgesic is less.
ObjectiveTo investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis. MethodsBetween January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect. ResultsThe 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean, 20.12 months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P<0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P<0.05) except the segmental kyphotic curves angle (P>0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was (3.04±1.17), (2.81±0.93), and (0.75±0.50)°, respectively. ConclusionFor patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.