Extended Robotic Pulmonary Resections

Scheinerman, Joshua A.; Jiang, Jeffrey; Chang, Stephanie H.; Geraci, Travis C.; Cerfolio, Robert J.

doi:10.3389/fsurg.2021.597416

Cited by 7 publications

(10 citation statements)

References 40 publications

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“…Robotic PN has been gradually developed in recent years. The robotic approach offers many technical advantages, such as accurate identification of tissue planes, better optics, natural movement of the operator's hand is used to control the instrument for safe dissection and more ergonomic ( 37 ). May be better in long-term overall survival of PN.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study

Wang¹,

Wang³

et al. 2022

Front. Surg.

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BackgroundPrognostic factors in a pneumonectomy (PN) are not yet fully defined. This study sought to analyze and evaluate long-term survival after pneumonectomies (PNs) for patients with non-small cell lung cancer (NSCLC).MethodsWe obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PNs between 2004 and 2015. Propensity score matching (PSM) analysis and Kaplan–Meier curves were used to estimate overall survival (OS), while univariate and multivariable Cox proportional hazards regression analyses were applied to create a forest plot.ResultsIn total, 1,376 patients were grouped according to right/left PNs. Before matching, OS was worse after a right PN [hazard ratio (HR): 1.459; 95% CI 1.254–1.697; P < 0.001] and after matching, survival differences between groups were not significant (HR: 1.060; 95% CI 0.906–1.240; P = 0.465). Regression analysis revealed that age, gender, grade, lymph node dissection, N-stage, and chemotherapy were independent predictors of OS (P < 0.05). Chemotherapy was associated with improved OS (P < 0.001).ConclusionsLaterality was not a significant prognostic factor for long-term survival after a PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS. Long-term survival and outcomes analyses should be conducted on larger numbers of patients.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study

Wang¹,

Wang³

et al. 2022

Front. Surg.

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“…Thanks to the encouraging results obtained by using the robotic-assisted approach in thoracic surgery, it has been possible to extend the indications for this approach also to more challenging procedures [ 19 ]. Meanwhile, the trend of increasing life expectancy makes it necessary to offer the safest surgical approach possible, preferably in association with minimum traumatism, to patients considered frailer, being featured with high perioperative risk.…”

Section: Discussionmentioning

confidence: 99%

Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients

Zirafa

Romano

Sicolo

et al. 2021

JCM

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Robotic-assisted pulmonary resection has greatly increased over the last few years, yet data on the application of robotic surgery in high-risk patients are still lacking. The objective of this study is to evaluate the perioperative outcomes in ASA III-IV patients who underwent robotic-assisted lung resection for NSCLC. Between January 2010 and December 2017, we retrospectively collected the data of 148 high-risk patients who underwent lung resection for NSCLC via a robotic approach at our institution. For this study, the prediction of operative risk was based on the ASA-PS score, considering patients in ASA III and IV classes as high-risk patients: of the 148 high-risk patients identified, 146 patients were classified as ASA III (44.8%) and two as ASA IV (0.2%). Possible prognostic factors were also analysed. The average hospital stay was 6 days (8–30). Post-operative complications were observed in 87 (58.8%) patients. Patients with moderate/severe COPD developed in 33 (80.5%) cases post-operative complications, while elderly patients in 25 (55%) cases, with a greater incidence of high-grade complications. No difference was observed when comparing the data of obese and non-obese patients. Robotic surgery appears to be associated with satisfying post-operative results in ASA III-IV patients. Both marginal respiratory function and advanced age represent negative prognostic factors. Due to its safety and efficacy, robotic surgery can be considered the treatment of choice in high-risk patients.

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“…Scheinerman et al 5 reported another series of 23 patients receiving sleeve lobectomy using RAS with minimal morbidity and without short-term mortality. They designed and used four robotic ports and one assistant port.…”

Section: Discussionmentioning

confidence: 99%

“… 32 (2) In a cohort of 23 cases, there was one case of pneumonia and one of transfusion, but no anastomotic complications. 5 (3) In a cohort of 21 cases, there were two cases of pneumonia, two cases of pyothorax, and only one of anastomotic leak. 33 All of the studies with small sample sizes demonstrated that the incidence of anastomotic complications when using RAS was promisingly low.…”

Section: Discussionmentioning

confidence: 99%

“…With the development of endoscopic technology and artificial intelligence, robotic-assisted surgery (RAS) systems have been utilized for sleeve lobectomies. 4 , 5 Although their results are encouraging, a longer learning curve, lack of tactile feedback to the operator, and tricky bronchial anastomosis RAS techniques are all associated issues that remain unresolved. 6 – 8 Some current studies have pointed out that visual compensation may be a better alternative to the tactile feedback once the surgeon is proficient.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique

Tao

Yuan

Kang

et al. 2021

Technol Cancer Res Treat

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Objective: To evaluate the clinical significance of an optimized approach to improve surgical field visualization and simplify anastomosis techniques using robotic-assisted sleeve lobectomy for lung or bronchial carcinoma. Method: A total of 26 consecutive patients who underwent sleeve lobectomy between January 2017 and April 2020 were enrolled in the study. The cohort included 11 cases of robotic-assisted surgery (RAS group) and 15 cases of mini-thoracotomy (MT group). RAS was performed via an exclusive optimized approach utilizing the “3 to 4-6 to 8/9” four-port technique. Retrieved demographical and clinical data included operation time, anastomosis time, blood loss, chest drainage time and volume, postoperative pain scores, complications, white blood cell (WBC) levels, and duration of hospital stay and follow-up. Results: No cases of perioperative death were recorded. Compared to MT group, the RAS group had a similar anastomosis time (30.82 ± 6.08 vs 33.20 ± 7.73 min, respectively, p > 0.05) and shorter operation time (189.73 ± 36.41 vs 225.33 ± 38.19 min, respectively, p < 0.05). The RAS group had lower pain scores (4.23 ± 0.26 vs 4.91 ± 0.51, p < 0.05), lower levels of WBC (p < 0.05), and no anastomotic complications postoperatively. The RAS and MT groups demonstrated a successful bronchus reconstruction with low risk of angulation (1/11 vs 1/15, p > 0.05) and satisfactory disease-free survival (eight cases, 72.73% and 12 cases, 80%, respectively). Conclusion: The optimized approach to RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes. Further study with a large sample size and evaluation of long-term survival are warranted. Key points: (i) we present a novel, convenient, and efficient approach for robotic-assisted sleeve lobectomy, ie, “3 to 4-6 to 8/9” four-port technique. The optimized approach for RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes; (ii) details for the “3 to 4-6 to 8/9” four-port method: the assistant port was located at the fourth intercostal space. The 1-cm camera port was inserted at the sixth intercostal space in the posterior axillary line. The 0.5-cm da Vinci ports of the instrument arms were placed at the third intercostal space in the anterior axillary line and the eighth or ninth intercostal space in the posterior axillary line. The patient cart was inserted from the back of the patient's head and shoulders at 75° to the longitudinal line.

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Extended Robotic Pulmonary Resections

Cited by 7 publications

References 40 publications

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study

Robotic Surgery for Non-Small Cell Lung Cancer Treatment in High-Risk Patients

Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique

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