Robotic Bronchial Sleeve Lobectomy for Central Lung Tumors: Technique and Outcome

Jiao, Wenjie; Zhao, Yandong; Qiu, Tong; Xuan, Yunpeng; Sun, Xiao; Qin, Yi; Liu, Ao; Sui, Tianyi; Cui, Jian

doi:10.1016/j.athoracsur.2019.02.028

Cited by 38 publications

(41 citation statements)

References 16 publications

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“…In our experience, we have had no conversions. We found a longer LOS in this group rather than standard procedure or those described in [6] . First, patients requiring this procedure might have comorbidities and thus are at risk of complications, thereby requiring more hospital care.…”

Section: Discussioncontrasting

confidence: 48%

“…The use of barbed wire secures the tension adaptation of the running suture, but it is not mandatory. Previously published small series of patients have described the use of braided waxed sutures such as Vicryl running sutures or separate sutures and the use of monofilament such as polydioxanone [6,[10][11][12][13][14] . These papers show similar outcomes to our series but do not describe our fully-closed-chest four-arm robotic technique.…”

Section: Discussionmentioning

confidence: 99%

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Robotic bronchial sleeve resections: technical details and early results

Durand¹

2019

MIS

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Aim: We report our four-arm robotic bronchial sleeve anatomical lung resection technique and its early results. Methods: We retrospectively collected all the four-arm robotic sleeve anatomical lung resections we performed in our institution from February 2014 to August 2019. We reported the results as a series of cases. Results: During that period, 582 robotic procedures were performed by a single surgeon, of which 486 were major anatomical lung resections. From this group, 10 patients (2%) underwent bronchial sleeve resections. All patients were treated on the right lung. Neither conversion nor major events occurred during surgery. The first bronchial sleeve was performed for Patient 219. The mean length of procedure was 164 (± 43) min. One patient died during hospitalization due to a non-related complication (gastric massive bleeding). Three patients had no complications. Six had minor complications (Clavien Dindo Grade 2) resulting in prolonged length of stay. The mean length of stay was 10 (± 5.7) days. No bronchial fistula occurred. All resection margins were R0. Conclusion: Four-arm robotic bronchial sleeve is a feasible and safe procedure. Telemanipulation surgery offers excellent technical conditions to ensure a hand-sewed anastomosis and R0 resection. The technical principle and dissection are the same as those of open surgery. Patient selection and mastering of the telemanipulation device are mandatory to perform these complex and rare procedures.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Robotic bronchial sleeve resections: technical details and early results

Durand¹

2019

MIS

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“…3 dimensional view, precision of movements, alignment between surgeon eyes and target, surgeon's comfort and an empowerment of his/her capabilities that can control up to 4 tools concurrently by two hands. Advantages in terms of clinical benefits for patients treated with robotic approach versus others minimally invasive techniques is more difficult to demonstrate for standard lobectomies, but (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Overview of the outcomes of robotic segmentectomy and lobectomy

Veronesi¹,

Novellis²,

Perroni³

2021

J Thorac Dis

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Segmentectomy has gained popularity in the latest years as a valid alternative to lobectomy.Initially reserved to patient unfit for lobar lung resection, this procedure is now offered also in selected patient with <2 cm peripheral lung cancer confined to an anatomic segment with no nodal involvement on preoperative evaluation. The introduction of screening with low-dose CT chest scan allowed the identification of lung cancer at early stages, making possible to schedule a more conservative lung surgery.A major improvement came also from minimally invasive surgery (MIS), reducing complication rate with comparable survival rates when compared to open surgery. However, due to long learning curve and uncomfortable instruments handling of video-assisted thoracoscopy, many surgeons still prefer to perform segmentectomies through a thoracotomy and thus increasing perioperative morbidity and leading to postthoracotomy syndrome due to rib-spreading. Robotic assisted thoracic surgery (RATS) can avoid this throwback, combining the handling of open surgery with lesser invasiveness of thoracoscopy. Although literature has given strong evidences in favour of robotic lobectomies, data are still limited regarding segmentectomies performed with this technique. Moreover, no results are still available from the two ongoing randomized controlled trials comparing segmentectomy to lobectomy and so the latter represent the oncologically proper procedure for lung cancer along with lymph-node dissection. In this review we analyse the literature currently available on outcomes of lobar and sublobar anatomical resection performed by RATS, with a brief mention of the existing surgical techniques of port positioning and the costs of this procedure.

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“…These reports consistently conclude that the procedure as both feasible and safe in select patients. The largest single-institutional series of 67 patients undergoing robotic bronchial sleeve lobectomy reported a 21% morbidity rate, no conversions to open, and no mortalities within 90 days (7). This series reported a mean duration of surgery of 167 minutes with a bronchial anastomosis time of 21 minutes.…”

Section: Sleeve Lobectomymentioning

confidence: 88%

Beyond the learning curve: a review of complex cases in robotic thoracic surgery

Geraci¹,

Scheinerman²,

Chen³

et al. 2021

J Thorac Dis

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The number of thoracic surgery cases performed on the robotic platform has increased steadily over the last two decades. An increasing number of surgeons are training on the robotic system, which like any new technique or technology, has a progressive learning curve. Central to establishing a successful robotic program is the development of a dedicated thoracic robotic team that involves anesthesiologists, nurses, and bed-side assistants. With an additional surgeon console, the robot is an excellent platform for teaching. Compared to current methods of video-assisted thoracoscopic surgery (VATS), the robot offers improved wristed motion, a magnified, high definition three-dimensional vision, and greater surgeon control of the operation. These advantages are paired with integrated adjunctive technology such as infrared imaging. For pulmonary resection, these advantages of the robotic platform have translated into several clinical benefits, such as fewer overall complications, reduced pain, shorter length of stay, better postoperative pulmonary function, lower operative blood loss, and a lower 30-day mortality rate compared to open thoracotomy. With increased experience, cases of greater complexity are being performed. This review article details the process of becoming an experienced robotic thoracic surgeon and discusses a series of challenging cases in robotic thoracic surgery that a surgeon may encounter "beyond the learning curve". Nearly all thoracic surgery can now be approached robotically, including sleeve lobectomy, pneumonectomy, resection of large pulmonary and mediastinal masses, decortication, thoracic duct ligation, rib resection, and pulmonary resection after prior chest surgery and/or chemoradiation.

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Robotic Bronchial Sleeve Lobectomy for Central Lung Tumors: Technique and Outcome

Cited by 38 publications

References 16 publications

Robotic bronchial sleeve resections: technical details and early results

Robotic bronchial sleeve resections: technical details and early results

Overview of the outcomes of robotic segmentectomy and lobectomy

Beyond the learning curve: a review of complex cases in robotic thoracic surgery

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