ObjectiveTo summarize the surgical learning curve and evaluate the effectiveness, safety and feasibility of the robotic-assisted thoracoscopic surgery (RATS) by comparing with the conventional vedio-assisted thoracoscopic surgery (VATS).MethodsThe clinical data of 40 patients receiving robotic assisted thoracoscopic anatomic lung resection from March to June 2016 in our department were reviewed. There were 29 males and 11 females with the age of 54-78 (60.2±12.7) years in the RATS group, and 27 males and 10 females with the age of 52-76 (58.7±11.5) years in the VATS group. Lung space-occupying lesions were comfirmed by preoperative diagnosis. The operative time, blood loss, chest tube retention time, postoperative hospital stay and perioperative morbidity and mortality were analyzed. The safety and feasibility were evaluated, and the learning curve was summed up.ResultsOperative time, postoperative ventilation time, intraoperative blood loss, chest tube retention time, postoperative pain, average hospital stay, postoperative complication rate between two groups were not statistically significant. In the RATS group preoperative preparation time was longer than that of the VATS group (24.5 min vs. 15.6 min, P=0.003), and the rate of conversion to thoracotomy of the RATS group was lower than that of the VATS group (0 vs. 10.8%). There was no perioperative death in two groups.ConclusionRobotic-assisted thoracic surgery is safe and effective in the early learning process, and the learning curve can be entered into the standard stage from the learning stage after initial 10 operations.
Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
ObjectiveTo compare the effect on postoperative immune function between da Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) , and to provide clinical support for more effective surgical procedures.MethodsA total of 90 patients undergoing radical resection of pulmonary carcinoma in our hospital from June to November 2019 were included. There were 49 males and 41 females with an average age of 62.67 (37-84) years. Among them, 50 patients underwent da Vinci robot-assisted thoracoscopic surgery (a RATS group) and 40 patients underwent video-assisted thoracoscopic surgery (a VATS group). The perioperative indexes as well as postoperative inflammatory factors and immune level effects between the two groups were compared.ResultsCompared with the VATS, RATS could significantly shorten the operation time and decrease intraoperative blood loss (P<0.05). RATS also effectively reduced the increase of postoperative inflammatory factor level (P<0.05). But there was no significant difference in postoperative immune function between the RATS group and the VATS group (P>0.05).ConclusionRATS is superior to VATS in the treatment of non-small cell lung cancer in perioperative indicators and inflammatory factors.
ObjectiveTo systematic evaluation of the difference in clinical outcomes between minimally invasive lung segment resection and lobectomy resection for stageⅠA non-small cell lung cancer (NSCLC) in order to provide reference for clinical application. MethodsOnline databases including The Cochrane Library、PubMed、EMbase、Web of Science、Sinomed、CNKI、WanFangwere searched from inception to January 21, 2023 by two researchers independently. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The prognostic indicators included the overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The meta-analysis was performed by STATA 14.0. Results A total of 13 studies with 1853 patients were enrolled in the final study, with NOS scores≥7 points. The results of meta-analysis showed that compared with the MILLR group, the blood loss was less [SMD=−0.36, 95%CI (−0.49, −0.23), P=0.000], postoperative drainage tube retention time [SMD=−0.34, 95%CI (−0.62, −0.05), P=0.019] and hospitalization time [SMD=−0.28, 95%CI (−0.40, −0.15), P=0.000] were shorter in the MILSR group. More lymph nodes [SMD=−0.65, 95%CI (−0.78, −0.53), P=0.000] and shorter operation time [SMD=0.20, 95%CI (0.07, 0.33), P=0.003] were found in the MILLR group. There were no significant differences in the incidence of postoperative complications, postoperative recurrence rate, DFS or RFS between the two groups. Conclusion Although the number of lymph nodes removed by MILSR is limited compared with MILLR, it does not affect the prognosis. MILSR has advantages in reducing intraoperative blood loss and shortening postoperative catheter time and hospital stay. For the surgical treatment of stageⅠA NSCLC, MILSR may be a more appropriate surgical approach.
ObjectiveTo compare the short-term clinical effects of Da Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the treatment of posterior mediastinal tumors, and to explore the advantages of RATS posterior mediastinal tumor resection. MethodsThe clinical data of patients who underwent posterior mediastinal tumors resection through the lateral chest approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between January 2019 to January 2023 were retrospectively analyzed. According to the different surgical methods, the patients were divided into a RATS group and a VATS group. The clinical data were compared between the two groups. ResultsA total of 85 patients were included in this study. There were 39 patients in the RATS group, including 25 females and 14 males, with an average age of 47.6±13.0 years, and 46 patients in the VATS group, including 14 males and 32 females, with an average age of 45.3±14.7 years. All patients completed the operation successfully. The hospitalization cost in the RATS group was significantly higher than that in the VATS group (P<0.001), and the white blood cell count and neutrophilic granulocyte percentage on the first day after operation in the RATS group were lower than those in the VATS group, and the differences were statistically significant (P<0.05). The operative time, intraoperative bleeding, postoperative hospital stay, white blood cell count and neutrophil percentage on the third postoperative day, visual analogue scale score on the first and third postoperative days, duration of analgesic pump use, postoperative 12 h oxygen saturation (no oxygen inhalation), postoperative down bed time, total thoracic drainage volume, duration of drainage tube retention, and postoperative complication rates were not statistically different between the two groups (P>0.05). There was no perioperative death, conversion to thoracotomy or serious perioperative complications in both groups. ConclusionRATS resection of posterior mediastinal tumor via lateral thoracic approach is safe and feasible, and its short-term effect is similar to that of VATS via lateral thoracic single-hole approach. It is worth further comparative study to explore its benefit and cost performance.