Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Straughan, David M.; Fontaine, Jacques; Toloza, Eric M.

doi:10.1177/107327481502200310

Cited by 13 publications

(8 citation statements)

References 53 publications

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“…Meta-analysis showed blood loss was minimal with no postoperative complications (38). In the current report patients had minimal blood loss and no postoperative complications, similar to other reports in the literature (39,40).…”

Section: Discussionsupporting

confidence: 90%

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

Buitrago¹,

Restrepo²

2019

Ann. Cardiothorac. Surg.

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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.

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Section: Discussionsupporting

confidence: 90%

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

Buitrago¹,

Restrepo²

2019

Ann. Cardiothorac. Surg.

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“…The time required to dock, undock, and exchange instruments is time-consuming in robotic surgery (7). However, the median total surgical time in our case series was not inferior to traditional trans-subxiphoid thoracoscopic thymectomy (8).…”

Section: Discussionmentioning

confidence: 79%

Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes

Zhang¹,

Chen²,

Zheng³

et al. 2018

J. Thorac. Dis.

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Background: Trans-subxiphoid thoracoscopic thymectomy is a promising procedure but technically demanding associated with ergonomic discomfort. In order to facilitate this complex procedure, the authors present a modified trans-subxiphoid thymectomy by the use of the Da Vinci robotic system. Methods:A 2-cm longitudinal incision for camera was made below the xiphoid process. Through this incision, the space among the posterior surface of the sternum, bilateral mediastinal pleura and diaphragm (extra pleural space) was enlarged blindly with a finger. Additional two operation holes were created below bilateral costal arches, and then two 8-mm robotic trocars were inserted into the extra pleural space. A third robotic instrument was placed in the 5th intercostal space after bilateral mediastinal pleura were dissected.The whole thymus was excised for patients with thymic tumor, and simultaneous resection of surrounding adipose tissues was performed for patients with myasthenia gravis. Clinical characteristics and early surgical outcomes of the patients were retrospectively collected and analyzed. Results: Between August 2016 and September 2017, 70 consecutive patients with myasthenia gravis or thymic neoplasm were successfully treated by the described surgical procedure. The median overall operative time was 115 (range, 60-150) min. The median hospital stay was 5 (range, 4-7) days. The median duration of chest tube was 3 (range, 1-8) days. The blood loss was minimal for all the patients. There was no mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusions: Based on our preliminary experience, the described technique of thymectomy is safe and feasible, and provides an optimal access for the robot camera and the instruments. According to the description of Suda' paper, a conventional thoracoscopy must be used to open bilateral pleura before the robotic instruments reach the operative field in the anterior mediastinum. Herein, we introduce a modified procedure of robot-assisted trans-subxiphoid thymectomy which the whole operation can be completed by Da Vinci surgical system without the additional use of conventional thoracoscopy. Methods PatientsA total of 70 consecutive patients with myasthenia gravis or anterior mediastinal mass underwent robot-assisted trans-subxiphoid thymectomy during August 2016 and September 2017 in the Department of Thoracic Surgery, West China Hospital, Sichuan University. The operations were performed by a single surgical team experienced in both robotic surgery and trans-subxiphoid thoracoscopic thymectomy. The study protocol was approved by the applicable institutional review board. Written informed consents were obtained from all patients.Patients who were preoperatively diagnosed with resectable thymic neoplasms or myasthenia gravis were included in this study. Exclusion criteria: (I) patients had impaired cardiac, kidney, liver or lung function and had a great risk; (II) preoperative CT scan revealed that patients with advanced tumors...

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“…The introduction of da Vinci surgical system has overcome the surgical limits of VATS. The three-dimensional (3D) vision and the endowirst technology improved vision of the operative field and reduced hand tremors from surgeon allowing greater technical precision (7,8). In particular the use of articulating instruments allowed to operate in limited and finite area so as anterior mediastinum with fine dissection around organs, vessel and corner when compared with VATS.…”

Section: Discussionmentioning

confidence: 99%

Anterior bronchogenic mediastinal cyst as priority procedure for robotic thoracic surgery

et al. 2017

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Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Abstract: Background: Tumors of the mediastinum as well as normal thymus glands in patients with

Cited by 13 publications

References 53 publications

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

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

Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes

Anterior bronchogenic mediastinal cyst as priority procedure for robotic thoracic surgery

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