Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

Abstract

Background:The present study aimed to assess the short-term consequences of biportal robot-assisted lobectomy, validating its safety and effectiveness. Methods: A retrospective analysis evaluated the clinical data and short-term results of 18 patients in the single medical group of the centre who underwent biportal robot-assisted lobectomy plus lymph node dissection from November 2020 to March 2021. Results: Lobectomy and lymph node dissection could be successfully accomplished in all 18 patients with the assistance of a biportal robot; there was no conversion to thoracotomy during the operation. There were 10 males and 8 females with their ages ranging from 37 to 73 (58.83 � 9.07) years. The total operation time was 74-146 (105.06 � 18.22) min. Punching time was 2-9 (5.11 � 1.74) min. Docking time was 8-16 (11.94 � 2.41) min. Console time was 50-104 (78.06 � 17.40) min. Chest closing time was 8-17 (10.28 � 2.74) min. Blood loss was 60-132 (94.11 � 41.41) ml. The number of lymph nodes dissected was 16-30 (21.78 � 4.13). Chest tube duration was 2-10 (4.06 � 1.98) days. Drainage on the first day following surgery was 100-500 (337.22 � 117.01) ml. Total drainage was 370-1100 (692.78 � 161.01) ml. Duration of hospital stay was 4-12(5.89 � 1.94) days. The median 24 and 72 h visual analogue score scores were 4 (3-7) and 3 (2-5). Total cost (¥) was 51 000-85 000 (68 000 � 10 000), respectively.There was one case of atrial fibrillation and one case of pulmonary infection. The complication rate was 11.11%. No serious complications were recorded after surgery, and no deaths occurred within 30 days post-surgery. The final pathological diagnosis revealed 10 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 1 case of benign disease. Conclusion:The biportal robot-assisted lobectomy was found to be safe and effective in the treatment of lung cancer.

Dual-Portal Robotic-Assisted Thoracic Surgery (DRATS) and Indocyanine Green-Navigated Segmentectomy

“…Yang and colleagues already reported and experience with the D-RATS approach, with 18 cases, considering it a safe and feasible technique (15). Watanabe and colleagues in their work describe 20 cases of planned D-RATS for anatomical pulmonary resections, with no need for conversions to thoracotomy and no need for extra ports (16).…”

Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review

“…Yang et al reported a 3-arm biportal approach with an arm port in the 8th intercostal space on the posterior axillary line and 2 arms (camera included) and assistant access in a 4 cm incision in the 6th intercostal space on the anterior axillary line, as schematically shown in Fig. 7 [ 28 ]. Another interesting case series was published by Qu et al on 3-arm biportal robotic sleeve lobectomies, with a similar approach, but accesses shifted upwards of one intercostal space [ 29 ].…”

“…Even more recent techniques such as biportal and uniportal RATS have performed well with satisfactory operative outcomes. In particular, biportal demonstrated similar operative times to standard robotic approaches and conversion rate (0%) [ 28 ] and perioperative complications were satisfying [ 28 , 29 ].…”

Uniportal fully robotic-assisted major pulmonary resections

“…The pure URATS approach is defined as robotic thoracic surgery performed through a single intercostal incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers. We always recommend the transition from multiportal robotic-assisted thoracoscopic surgery (MRATS) to URATS through biportal-RATS ( 14 , 15 ), doing several anatomic resections first. It is important to differentiate a pure approach from the hybrid technique (URATS-UVATS) where the surgeon only does the dissection from the console and the assistant takes over the critical part of inserting the thoracoscopic staplers through the utility incision ( 16 ).…”