Robot-assisted thoracic surgery for complex procedures

Kuo, Shuenn‐Wen; Huang, Pei-Ming; Lin, Mong-Wei; Chen, Ke Cheng; Lee, Jang-Ming

doi:10.21037/jtd.2017.08.11

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Mean chest drain duration was 3.1 days (range: 2-5 days) and the mean hospital stay was 4.2 days (range: 3-7 days). The final pathological diagnoses were the following: thymoma [4], solitary fibrous tumor [1], multinodular goiter [3] and omental adipose tissue [1]. According to the World Health Organization (WHO) classification: 1 thymoma was type A, 2 type AB and 1 type B2.…”

Section: Resultsmentioning

confidence: 99%

Hybrid robotic thoracic surgery for excision of large mediastinal masses

Amore¹,

Cicalese²,

Scaramuzzi³

et al. 2018

J. Vis. Surg.

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Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.

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Section: Resultsmentioning

confidence: 99%

Hybrid robotic thoracic surgery for excision of large mediastinal masses

Amore¹,

Cicalese²,

Scaramuzzi³

et al. 2018

J. Vis. Surg.

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“…We describe a surgical technique detailing robotic-assisted anterior mediastinal mass resection with en bloc removal of lung and pericardium, and with patch repair of the pericardial defect. Although few reports have referenced robot-assisted thymectomy with partial pericardial resection in locally advanced cases (6,(9)(10)(11), they rarely describe the surgical technique and approach for these complex cases. Suda (12) provided a detailed description of the technical approach in a review article for robotic subxiphoid thymectomy with pericardial reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…In these locally advanced cases, en bloc thymectomy by median sternotomy has been considered as the standard approach. However, the evolutionary development of robotic systems and the accumulation of robotic surgery experience have allowed some experienced robotic surgeons to approach more complex and difficult cases with these techniques (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted en bloc anterior mediastinal mass excision with pericardium and adjacent lung for locally advanced thymic carcinoma

et al. 2018

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Robot-assisted surgery for anterior mediastinal mass resection has been increasingly adopted as an alternative method to open sternotomy and conventional video-assisted thoracic surgery. However, more evidence is needed to expand the indication of this technique to more complicated cases. We present a case of robot-assisted resection of a 7-cm anterior mediastinal mass with pericardium and adjacent lung for thymic squamous cell carcinoma, accompanied by reconstruction of pericardium with polytetrafluoroethylene patch. In conclusion, complex anterior mediastinal mass excision is feasible with robotic thoracic surgery.

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“…However, data on robotic pneumonectomy are confined to case reports and a few small case series. 1 -7 In fact, to date, only 7 completely robot-assisted pneumonectomies have been reported in the English literature. 8 Historically, anatomic contraindications to minimally invasive pneumonectomy such as large tumors, central location, inability to assess extent of needed resection (lobectomy vs pneumonectomy), and hilar invasion have largely limited pneumonectomy to the open approach.…”

Section: Introductionmentioning

confidence: 99%

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

Patton

Zarif

Bahroloomi

et al. 2021

Innovations�(Phila)

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Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

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Robot-assisted thoracic surgery for complex procedures

Abstract: RATS for complex thoracic procedures is feasible, especially for complex suturing and excision of very large mediastinal tumors, but more attention is needed for patients needing difficult dissections. Advanced preparation for conversion is necessary during this difficult operation.

Cited by 12 publications

References 24 publications

Hybrid robotic thoracic surgery for excision of large mediastinal masses

Hybrid robotic thoracic surgery for excision of large mediastinal masses

Robot-assisted en bloc anterior mediastinal mass excision with pericardium and adjacent lung for locally advanced thymic carcinoma

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

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