Robotic-assisted thoracoscopic lung surgery: anesthetic impact and perioperative experience

Heller, Joshua A.; Bhora, Faiz Y.; Heller, Benjamin J.; Cohen, Edmond

doi:10.23736/s0375-9393.17.12168-1

Cited by 6 publications

(5 citation statements)

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“…This might be due to reduced intra- and postoperative pain which could be achieved because the robotic arms are able to bend inside the chest and therefore produce less pressure on the ribs and the surrounding nerves ( 31 ). Intraoperatively reduced pain can lead to reduced stress of the patient and therefore might lead to better hemodynamic status during the procedure ( 32 ). The shortened ICU and hospitals stay is beneficial to the patient and reduces hospital expenditures, which in the long run could offset the higher cost of acquiring and maintaining a robotic system.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience

et al. 2022

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BackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.Material and methodsData of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.Results95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).ConclusionRobot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience

et al. 2022

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“…La RATS presenta resultados prometedores en cuanto a la reducción de dolor agudo postoperatorio por tratarse de una técnica mínimamente invasiva [4], [13]- [15]. El abordaje multimodal del dolor en la cirugía torácica debe considerarse mandatorio debido a las múltiples aferencias sensitivas tras la agresión quirúrgica [5], [16], con el objetivo de reducir al máximo las potenciales complicaciones del dolor agudo postoperatorio, así como la cronificación del dolor [11], [15], [16]. La técnica regional por excelencia en la toracotomía ha sido, tradicionalmente, la analgesia epidural torácica [17].…”

Section: Discussionunclassified

Abordaje anestésico en cirugía torácica asistida por robot: estudio de cohorte unicéntrico

Alvarez-Villegas¹,

Campistol²,

Puig³

et al. 2021

Rev. chil. anest.

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“…Depending on the spatial conditions in the individual surgical theaters, this may limit anesthesiological accessibility of the head, airways, and upper torso. Extensions for intravenous lines, the arterial line, and the airway circuit may be necessary [19]. It is mandatory that the anesthesiology staff ensure that these vital connections are visible and accessible.…”

Section: Peri-and Intraoperative Considerationsmentioning

confidence: 99%

“…The surgical team including anesthesia and nursing teams should be prepared to complete this process swiftly. Therefore, all instruments for thoracotomy should be available in the operation room [19].…”

Section: Peri-and Intraoperative Considerationsmentioning

confidence: 99%

“…For the surgeon, the advantages of RATS include true 3dimensional imaging with binocular glasses and the use of multiarticular forceps that allow the performance of highprecision operations [18]. For both the surgeon and the anesthesiologist, there is a multitude of perioperative considerations for RATS surgery [19]. This article focuses upon preoperative patient optimization, intraoperative considerations for surgeons and anesthesiologists, and postoperative management of patients undergoing RATS surgery.…”

Section: Introductionmentioning

confidence: 99%

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Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

Niklas

Fakundiny

Попов

et al. 2021

Curr Anesthesiol Rep

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Purpose of Review This review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program. Recent Findings RATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction in operation theaters caused by the large robotic equipment longs for a reallocation of the anesthetist’s and surgeon’s working environment that may vary additionally depending on the type of surgery performed in the individual patient. Additionally, the implementation of a positive pressure carbon dioxide gas cavity in the pleura has a direct effect on patient cardio-circulatory and respiratory mechanics that have to be balanced by the anesthesiologist. Summary RATS advances by replacing open surgery approaches and will complement—but most likely not replace—video-assisted thoracoscopic surgery (VATS). RATS brings new specific intraoperative requirements to the anesthesiological and surgical team members that have to be implemented into clinical routine.

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Robotic-assisted thoracoscopic lung surgery: anesthetic impact and perioperative experience

Cited by 6 publications

References 0 publications

Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience

Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience

Abordaje anestésico en cirugía torácica asistida por robot: estudio de cohorte unicéntrico

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

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