Robotic Lobectomy: Right Upper Lobectomy

Veronesi, Giulia; Novellis, Pierluigi; Bottoni, Edoardo; Alloisio, Marco

doi:10.1053/j.optechstcvs.2017.06.002

Cited by 7 publications

(6 citation statements)

References 19 publications

(30 reference statements)

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“…Four robotic arms are introduced through 3 ports and a 3-cm long utility incision at the fourth intercostal space (RAL-4). The dissection of hilar structures is carried out from the anterior aspect with a fissureless technique for upper lobes (39). Through the utility incision, the bed assistant can introduce accessory thoracoscopic instruments and remove the specimen without rib spreading.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic surgery for locally advanced non-small cell lung cancer

Muriana¹,

Perroni²,

Novellis³

et al. 2021

J Vis Surg

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Stage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases including large masses, mediastinal lymph node involvement, and invasion of major mediastinal structures. Robotic surgery is a minimally invasive approach recognized as an equivalent alternative to open surgery in case of early stage NSCLC. An increasing number of studies also assert that robotics is a reasonable option for the treatment of locally advanced disease in the setting of multimodality therapy. Major advantages of the technique are increased radicality compared to video-assisted thoracic surgery (VATS), fast postoperative recovery and better compliance to adjuvant therapies compared to open. In this paper we present some technical aspects of the robotic lobectomy in locally advanced disease, we discuss different robotic approaches and review the literature of robotic treatment of lung cancer patients. To describe the technique, we use two case studies of patients affected by locally advanced NSCLC operated with robotic surgery. A patient with right upper lobe (RUL) pulmonary adenocarcinoma and single N2-station metastasis underwent robotic lobectomy following response to induction chemo-radiotherapy. A radical excision of the tumor was obtained with clear margins and no evidence of residual disease at pathologic examination. In the second case, a diagnosis of N2 lymph node metastasis (station R4) from pulmonary adenocarcinoma was made in a patient with primary occult tumor. After induction treatment, the patient underwent robotic radical mediastinal lymph node dissection with curative intent. Unexpected partial invasion of the wall of superior vena cava (SVC) was safely managed with tangential resection. Despite the problems of costs, availability, and learning curve, the Authors believe that robotic surgery has indisputable advantages to obtain a radical resection in case of locally advanced NSCLC.

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Section: Discussionmentioning

confidence: 99%

“…Usually, in case of early-stage disease, the operation starts with the isolation of hilar vascular structures with an anterior-to-posterior fissureless approach (39). Following induction treatment, a pathologic assessment of the response to chemo-radiotherapy is crucial to confirm the indication to lobectomy.…”

Section: Surgical Technique (Video 1)mentioning

confidence: 99%

Robotic surgery for locally advanced non-small cell lung cancer

Muriana¹,

Perroni²,

Novellis³

et al. 2021

J Vis Surg

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“…1 e); and insertion and closure of the stapler (Fig. 1 f) 26 . Between the last two steps, the right instrument is changed by a surgical technician.…”

Section: Methodsmentioning

confidence: 99%

Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation

Gamberini,

Maglio,

Mariani

et al. 2024

Sci Rep

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The number of robot-assisted minimally invasive surgeries is increasing annually, together with the need for dedicated and effective training. Surgeons need to learn how to address the novel control modalities of surgical instruments and the loss of haptic feedback, which is a common feature of most surgical robots. High-fidelity physical simulation has proved to be a valid training tool, and it might help in fulfilling these learning needs. In this regard, a high-fidelity sensorized simulator of vascular structures was designed, fabricated and preliminarily validated. The main objective of the simulator is to train novices in robotic surgery to correctly perform vascular resection procedures without applying excessive strain to tissues. The vessel simulator was integrated with soft strain sensors to quantify and objectively assess manipulation skills and to provide real-time feedback to the trainee during a training session. Additionally, a portable and user-friendly training task board was produced to replicate anatomical constraints. The simulator was characterized in terms of its mechanical properties, demonstrating its realism with respect to human tissues. Its face, content and construct validity, together with its usability, were assessed by implementing a training scenario with 13 clinicians, and the results were generally positive.

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“…Conversely, a 4-port approach was used in the case of robotic lobectomies or segmentectomies, with a 3-cm utility incision without rib spreading and no routine CO 2 insufflation. DaVinci Robotic System Xi was used with a 30° camera and standard endoscopic staplers [ 11 , 12 , 13 , 14 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer

Novellis

Maisonneuve

Dieci

et al. 2021

JCM

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We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic resection, were enrolled in a single-center prospective study from April 2016 to December 2018. EORTC QLQ-C30 and QLQ-LC13 scores were obtained preoperatively and, at three time points, postoperatively. RATS and VATS groups were matched for ASA scores, while RATS and open surgery were matched for gender, ASA score, cancer stage, and tumor size; 58 patients underwent open surgery, 58 had VATS, and 53 had RATS. Hospital stay was shorter after RATS than OPEN (median 4.5 versus 5; p = 0.047). Comparing matched RATS and VATS groups, the number of hilar lymph nodes and nodal stations removed was significantly higher in the former approach (p = 0.01 vs. p < 0.0001); conversely, pain at 2 weeks was slightly lower after VATS (p = 0.004). No significant difference was observed in conversions, complications, duration of surgery, and postoperative hospitalization. The robotic approach was superior to OPEN in terms of QOL, pain, and length of postoperative stay and showed improved lymph node dissection compared to VATS.

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Robotic Lobectomy: Right Upper Lobectomy

Cited by 7 publications

References 19 publications

Robotic surgery for locally advanced non-small cell lung cancer

Robotic surgery for locally advanced non-small cell lung cancer

Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation

Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer

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