Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Abstract

Background: Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. Methods: This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. Results: Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). Conclusions: This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

Global status of the robotic thoracic surgery

“…In a series recently published by Terra et al, 250 cases were reported including not only lung resection but also mediastinal tumors resections and diaphragmatic plication (23,24). In 2019, Buitrago and Restrepo published the second series of RATS in Latin America, with 14 cases of pulmonary resections showing comparable perioperative results to other reports (25).…”

Robotic Cardiac Surgery in Colombia: Overcoming the Challenges of a Middle-income Setting

“…As the pursuit of optimal and universal health care continues, the next step with regard to optimizing access to quality cardiac surgical care pushes more towards bundled payment models [ 7 ] . At the moment, robotic surgery in Colombia is still in its infancy, with only 5 centers in the country having robotic consoles, and only one center performing robotic cardiac surgery [ 1 - 3 , 5 ] . Throughout the years, cardiothoracic surgery in Colombia has grown following American footsteps and techniques.…”

“…Although Colombia began performing minimally invasive (MICS) and video-assisted cardiac procedures since the mid 1990s, they were not routine until 2010. With regard to advances in minimally invasive cardiothoracic surgery, the country has come a long way from long traditional incisions to video-assisted and minimally invasive cardiac and thoracic surgeries, robotic thoracic surgery in 2012, and uniportal video-assisted thoracoscopic surgery (VATS) in 2014 [ 1 - 3 ] . Although robotic cardiac procedures offer many advantages to patients, this approach is still finding its place, even in high-income countries.…”

The feasibility and advantages of immediate removal of urinary catheter after lobectomy: A prospective randomized trial

“…The removal of an entire lung lobe is called a lobectomy, and video‐assisted thoracoscopic surgery (VATS) lobectomy has become a minimally invasive surgical procedure for lung cancer resection (Guido‐Guerrero et al., 2018 ; Nachira et al., 2018 ; Buitrago and Restrepo, 2019 ; Raveglia et al., 2019 ). It becomes a routine preparatory step that an indwelling urinary catheter is used to prevent intraoperative urinary retention (Van Backer et al., 2019 ) in VATS lobectomy.…”