Incidence, Management, and Outcomes of Intraoperative Catastrophes During Robotic Pulmonary Resection

Cao, Christopher; Cerfolio, Robert J.; Louie, Brian E.; Melfi, Franca; Veronesi, Giulia; Razzak, Rene; Romano, Gaetano; Novellis, Pierluigi; Shah, Savan; Ranganath, Neel K.; Park, Bernard J.

doi:10.1016/j.athoracsur.2019.05.020

Cited by 49 publications

(42 citation statements)

References 26 publications

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“…As the branching pattern of pulmonary vessels is diverse, dissecting around the arterial trunk of in LUL are intertwined to bronchi and veins, lead to a potential risk of uncontrollable intraoperative bleeding. As the left upper lobe lobectomy has been considered as the most challenging procedure technically, previous reports on conventional VATS have reported ndings with catastrophic rates of 1% to 1.5% and pulmonary arterial bleeding was more frequent during VATS left upper lobectomy [15][16][17] . It is necessary to clarify the relationship between the various branching patterns of pulmonary vessels and bronchi.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, no clear relations among the various branching patterns of pulmonary vessels and bronchi are reported. As previous studies reported an intraopetaive vessels injury was more frequent during the left upper lobectomy [15][16][17] , this study anatomically analyzed the branches and courses of subsegmental PVs, which are characterized by considerable diversity in the branching patterns of blood vessels and bronchi, in the left upper lobe (LUL) of lung.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical Analysis of the Left Upper Lobe of Lung on Three-Dimensional Images with Focusing the Branching Pattern of the Subsegmental Veins

Isaka

Mitsuboshi²,

Maeda³

et al. 2020

Preprint

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Background: Although a clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and is important to avoid intraoperative pulmonary vessels injury, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing the PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated. Methods: The branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012. Results: Branching types of the bronchus and pulmonary vessels failed to be independent each other. Combinations of anterior extension type of bronchi with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein type with the M-type were often observed. LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns. Conclusions: This study found the relationship among PA, PV, and bronchus patterns, and in the subsegment where the branching patters were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomical Analysis of the Left Upper Lobe of Lung on Three-Dimensional Images with Focusing the Branching Pattern of the Subsegmental Veins

Isaka

Mitsuboshi²,

Maeda³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Novellis et al [2] reported an overall conversion rate of 6.2% (21/338) for major robotic lung resections, of which 1.1% (4/338) were due to bleeding. Other authors have reported overall conversion rates of 1.5%-9% with pulmonary artery or pulmonary vein injury resulting in conversion in 0.5%-2.6% [3][4][5][6][7] . In a retrospective multi-institutional study of 1,810 patients who underwent robotic anatomic pulmonary resections, Cao et al [4] reported intraoperative catastrophic events in 1.9% of patients Catastrophic events were associated with higher proportion of patients who underwent preoperative radiotherapy, higher perioperative mortality, longer operative times, and higher estimated blood loss.…”

Section: Introductionmentioning

confidence: 99%

“…The most common intraoperative bleeding complication during robotic lung resection is from an injury to the pulmonary artery. Most commonly, pulmonary artery injury occurs during dissection of the artery [4] . These injuries are easier to see as they occur directly at the point of dissection.…”

Section: Introductionmentioning

confidence: 99%

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Technique of robotic lobectomy III: control of major vascular injury, the 5 “P”’s

Gharagozloo¹,

Meyer²

2020

Mini-invasive Surg

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Robotic Lobectomy has been evolving over the past decade and has been shown to be an oncologically efficacious procedure. Although robotic lobectomy is performed more frequently in centers around the world, it accounts for a small percentage of all lobectomies. One of the major causes of reluctance to adopt robotic lobectomy and segmentectomy procedures by surgeons is the fear of bleeding complications, as well as the lack of a standardized reproducible approach to these potentially catastrophic events. This paper outlines a proven strategy for control of bleeding complications during robotic lobectomy and segmentectomy procedures: the 5 "P"'s of Prevention, Preparedness, Poise, Pressure, and Proximal Control.

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

Yang

Bai

et al. 2021

Robotics Computer Surgery

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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.

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Incidence, Management, and Outcomes of Intraoperative Catastrophes During Robotic Pulmonary Resection

Abstract: have also helped to promote the popularization of robotic VATS internationally. [5][6][7] Despite these encouraging trends for robotic thoracic surgery, there is a paucity of robust clinical data on intraoperative catastrophes, partly due to their relative

Cited by 49 publications

References 26 publications

Anatomical Analysis of the Left Upper Lobe of Lung on Three-Dimensional Images with Focusing the Branching Pattern of the Subsegmental Veins

Anatomical Analysis of the Left Upper Lobe of Lung on Three-Dimensional Images with Focusing the Branching Pattern of the Subsegmental Veins

Technique of robotic lobectomy III: control of major vascular injury, the 5 “P”’s

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

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