ObjectiveTo evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with pulmonary lobectomy. MethodsWe retrospectively analyzed the clinical data of 50 patients in General Hospital of Shenyang Military Region of Thoracic Surgery between May 2012 and March 2015.The patients were divided into two groups. Twenty five patients aged over 70 years underwent radical operation of lung cancer with da Vinci Robot System were allocated into a robot group with 17 males and 8 females at age of 72.6 ±2.5 years. Another 25 senile patients with radical surgery by video-assisted thoracoscopic surgery (VATS) were allocated into a thoracoscopic group with 17 males and 8 females at age of 72.5±2.4 years. The patients in the two groups underwent pulmonary lobectomy and mediastinal lymph node dissection. The clinical effect of the two groups was compared. ResultsAll patients were diagnosed as lung cancer. Twenty five patients all completed surgery under da Vinci Robot System in the robot group. In the thoracoscopic group, one patient was converted to thoracotomy. There were statistical differences in amount of blood loss (66.2±44.2 ml vs. 356.0±349.2 ml, P=0.000), lymph node number (23.2±9.8 vs. 11.3±5.6, P=0.012), and postoperative bed time (3.5±0.9 d vs. 4.2±1.1 d, P=0.017) between the two groups. Effect in the robot group was superior to that in the thoracoscopic group. ConclusionDa Vinci robotic surgery system for elderly patients with lung cancer radical surgery is safe, effective, and less thoracoscopic surgery trauma, recovery faster.
ObjectiveTo investigate the effect of pressure control ventilation-volume guaranteed (PCV-VG) for patients undergoing da Vinci robotic-assisted pulmonary lobotomy. MethodA total of 40 patients undergoing Da Vinci robotic-assisted pulmonary lobotomy were randomly divided into two groups:a PCV-VG group (G group) and a volume-controlled ventilation (VCV) group (V group). There were 20 patients in each group with 13 males and 7 females at age of 49.0±5.5 years in the G group, 16 males and 4 females at age of 51.0±3.9 years in the V group. Haemodynamics indexes and oxygenation parameters were recorded at different times and compared between the two groups. ResultsDuring one-lung ventilation (OLV) period, the peak inspiratory pressure (Ppeak), respiratory index (RI) and arterial partial pressure of carbon dioxide (PaCO2) in the G group were statistically lower than those in the V group (P<0.05). While the Cdyn and inspired oxygen fraction(OI) were higher in the G group than those in the V group (P<0.05). ConclusionCompared with the traditional VCV ventilation mode, the PCV-VG ventilation mode improves Ppeak, Cdyn, OI, and RI of the patients undergoing da Vinci robotic-assisted pulmonary lobotomy.
ObjectiveTo investigate the feasibility and advantage of the da Vinci S Surgical System in operation of the mediastinal tumor without chest tube. MethodsFrom March 2011 up to March 2015, 39 patients in our hospital with mediastinal tumor underwent resection without a chest tube by da Vinci System were as a no chest tube group with 24 males and 15 females at age of 47.28 (18-73) years. In the same period, 50 patients with mediastinal cyst underwent resection with a chest tube insertion by da Vinci System were as a chest tube group with 25 males and 25 females at age of 49.24 (22-82) years. Clinical data of the two groups were collected and compared. ResultThere were statistical differences in mean operative time (61.97±16.41min vs. 79.90±33.19 min, P=0.003), time of ICU stay (1.23±0.48 d vs. 2.16±0.82 d, P=0.000), time of postoperative hospitalization (3.77±1.16 d vs. 5.62±2.22 d, P=0.000), and visual analogue scale (VAS) score (3.05±1.76 vs. 4.54±1.83). The clinical results in the no chest tube group were better than those in the chest tube group. All the procedures were successfully completed by da Vinci System in all the patients without conversions and any compilcation. ConclusionIt's safe and beneficial for patients without a chest tube after a mediastinal tumor resection with da Vinci S Surgical System with shorter hospital stay.
ObjectiveTo summarize our initial experience in robot-assisted left upper lobectomy for non-small cell lung cancer. MethodsFour patients with non-small cell lung cancer underwent robot-assisted left upper lobectomy with da Vinci S surgical system (Intuitive Surgical, California) in General Hospital of Shenyang Military Area Command between March and August 2013. There were 3 male and 1 female patients, and their age was 58.8 years (range:49-67 years). We used general anesthesia with double lumens trachea cannula. The patients set in right lateral decubitus position with jackknife. We used 3 arms of the robot system. A single direction lobectomy procedure or an anatomic lobectomy procedure was used according to the differentiation of fissure. Systemic lymph node dissection was performed for all patients. ResultsFour patients with left upper lobectomy were completed with total robotic procedure without conversion. Postoperative pathological examination showed all the patients were of all adenocarcinoma with 2 patients inⅠA stage and 2 patients inⅢA stage. The range of operating time was 100-150 min, intraoperative blood loss was 30-80 ml and no blood transfusion was needed for the patients. The drainage time was 6-20 days. All of the 4 patients were discharged smoothly. The patients were followed up for 10-15 months without recurrence or metastasis. ConclusionRobot-assisted left upper lobectomy is safe and feasible for non-small cell lung cancer.
ObjectiveTo compare the effect of da Vinci Surgical System and video-assisted mini-thoractomy (VAMT) on postoperative pain of patients with lungs or mediastinal tumor. MethodsWe retrospectively analyzed the clinical data of 88 patients with lung or mediastinal tumor who underwent surgical treatment in our hospital from January 2015 through April 2015. The patients were divided into two groups including a robot group and a VAMT group. There were 49 patients in the robot group with 23 males and 26 females at age of 55.14±13.03 years and 39 patients with 23 males and 16 females at age of 56.92±8.98 years in the VAMT group. ResultsCompared with the VAMT group, shorter operation time (t=-2.298, P=0.024) and shorter time of drainage (t=-2.421, P=0.018) were found in the robot group with statistical differences. There was a statistical difference in visual analogue scale (VAS) scores of postoperative 24 hours between the robot group and the VAMT group (1.00±0.74 vs. 2.33±1.64, t=-4.704, P=0.000). While no statistical difference was found in VAS scores of postoperative 48 hours (t=-0.244, P=0.808) between the two groups. ConclusionCompared with VAMT, da Vinci Surgical System can be used in the treatment of lung and mediastinal tumor with shorter operation time, shorter time of drainage, less pain, and less invasiveness.