Robot-assisted lobectomy versus completely portal robotic lobectomy: What is the difference?

Abstract

Background: This study aims to compare robot-assisted lobectomy versus completely portal robotic lobectomy. Methods: Between January 2014 and December 2019, a total of 41 patients (10 males, 31 females; median age 62 years; range, 50 to 68 years) underwent robotic anatomical pulmonary resection in our institution were retrospectively analyzed. The patients were consecutively divided into two groups: the first 20 (48.8%) patients underwent pulmonary resection by robot-assisted lobectomy technique, while the next 21 (51.2%) patients underwent pulmonary resection by completely portal robotic lobectomy with four arms. Data including age, sex, diagnosis, surgery type and duration, rate of conversion to open surgery, and length of stay of the patients were recorded. The operation time, docking time, console time, and closure duration for each patient were also noted. Results: There was no statistically significant difference in age, sex, comorbidities, complications, length of hospital stay, adequate lymph node staging, or tumor size and side between the two groups (p>0.05). However, the mean console and operation times were statistically significantly shorter in the patients receiving completely portal robotic lobectomy with four arms (p=0.001). Conclusion: The advantage of completely portal robotic lobectomy with four arms is relative, although it significantly shortens the operation time. Based on our experiences, this technique may be preferred in case of inadequate lung deflation, as carbon dioxide insufflation allows sufficient workspace for robotic lung resection.

Robotic portal resection for mediastinal tumours: a prospective observational study

“…The complete-portal robotic surgical technique provides many advantages over traditional robotic thoracic surgery with a utility incision. First, CO 2 insufflation provides a better view of the surgical field, extending the endoscopic field by lowering the diaphragm and compressing the lung [ 13 , 15 , 28 ]. This is particularly important for mediastinal tumour resection in remote and narrow spaces.…”

Robotic‐assisted thoracoscopic surgery improves perioperative outcomes in overweight and obese patients with non–small‐cell lung cancer undergoing lobectomy: A propensity score matching analysis

“…CPRL provides a fully enclosed thoracic operating space filled with warm CO 2 . The pressure of CO 2 can push down on the diaphragm and compress the lung parenchyma, increasing the surgeon's workplace and improving the surgical field 28 . In addition, the increased pressure in the thoracic cavity can also effectively inhibit the tissue of mild bleeding 30 .…”

“…During the past decade, the use of completely portal robotic lobectomy (CPRL) and uniportal VAL has rapidly increased. 28 , 29 Without using utility incision, CPRL and uniportal VAL allow thoracic surgeons to use CO 2 insufflation to achieve a better view of the surgical field. It has been reported that CPRL could significantly reduce intraoperative blood loss and shorten operative time.…”

“…The pressure of CO 2 can push down on the diaphragm and compress the lung parenchyma, increasing the surgeon's workplace and improving the surgical field. 28 In addition, the increased pressure in the thoracic cavity can also effectively inhibit the tissue of mild bleeding. 30 CPRL can also provide surgeons with better control over the surgical field, because they did not require the assistant to help retract the lung tissue and did not spend time communicating on retraction.…”