Uniquely Modified Robotic-Assisted Thoracic Surgery With Good Intrathoracic Visual Field

Funai, Kazuhito; Kawase, Akikazu; Mizuno, Kiyomichi; Koyama, Satoshi; Takanashi, Yusuke; Shiiya, Norihiko

doi:10.1016/j.athoracsur.2020.04.075

Cited by 8 publications

(11 citation statements)

References 2 publications

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“…A better view of the head in the chest cavity was obtained by raising the position of the camera arm. 20 In our study, the total operation time was 105.06 � 18.22 min, which is in agreement with the reported results of traditional robotassisted surgery, 24 but the docking time was longer as compared to the traditional multiportal operation time. The reason may be that multiple robot arms need to be placed in a single operation port and repeated adjustment of a certain angle and position between the arms is essential so that they do not affect each other.…”

Section: Discussionsupporting

confidence: 90%

“…A new mirror arm placement port, the 'Hamamatsu method', designed by the Hamamatsu University School of Medicine, effectively ameliorates the intraoperative vision. 20 Based on the traditional lateral approach, 21,22 Chang et al 23 removed the posterior axillary incisions to reduce the total number of incisions and developed an anterolateral approach, more appropriate for robotic systems. Through this procedure, 36 patients were resected of lung lobes, sleeves, lung segments and both lungs.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

Yang

Bai

et al. 2021

Robotics Computer Surgery

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Background:The present study aimed to assess the short-term consequences of biportal robot-assisted lobectomy, validating its safety and effectiveness. Methods: A retrospective analysis evaluated the clinical data and short-term results of 18 patients in the single medical group of the centre who underwent biportal robot-assisted lobectomy plus lymph node dissection from November 2020 to March 2021. Results: Lobectomy and lymph node dissection could be successfully accomplished in all 18 patients with the assistance of a biportal robot; there was no conversion to thoracotomy during the operation. There were 10 males and 8 females with their ages ranging from 37 to 73 (58.83 � 9.07) years. The total operation time was 74-146 (105.06 � 18.22) min. Punching time was 2-9 (5.11 � 1.74) min. Docking time was 8-16 (11.94 � 2.41) min. Console time was 50-104 (78.06 � 17.40) min. Chest closing time was 8-17 (10.28 � 2.74) min. Blood loss was 60-132 (94.11 � 41.41) ml. The number of lymph nodes dissected was 16-30 (21.78 � 4.13). Chest tube duration was 2-10 (4.06 � 1.98) days. Drainage on the first day following surgery was 100-500 (337.22 � 117.01) ml. Total drainage was 370-1100 (692.78 � 161.01) ml. Duration of hospital stay was 4-12(5.89 � 1.94) days. The median 24 and 72 h visual analogue score scores were 4 (3-7) and 3 (2-5). Total cost (¥) was 51 000-85 000 (68 000 � 10 000), respectively.There was one case of atrial fibrillation and one case of pulmonary infection. The complication rate was 11.11%. No serious complications were recorded after surgery, and no deaths occurred within 30 days post-surgery. The final pathological diagnosis revealed 10 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 1 case of benign disease. Conclusion:The biportal robot-assisted lobectomy was found to be safe and effective in the treatment of lung cancer.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

Yang

Bai

et al. 2021

Robotics Computer Surgery

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“…Postoperative complications were identified in 13 (12.0%), and the details were as follows: prolonged air leakage (PAL; n=7), cerebral infarction (n=2), chylothorax (n=1), pneumonia (n=1), anemia (n=1), surgical site infection (n=1) and syndrome of inappropriate secretion of ADH (SIADH; n=1), one patient experienced both cerebral infarction and SIADH. The median total number of stapler used was 6 (range, [3][4][5][6][7][8][9][10][11][12][13][14]. The chest tube was removed a median (range) of 1 (range, 1-17) days after the procedure.…”

Section: Resultsmentioning

confidence: 99%

“…We believe that this novel approach can make this operation very easy to perform and enable the operator to perform lobectomy like a standard open thoracotomy procedure. Furthermore, Funai et al also reported the arrangement of ports inserted into the thoracic cavity to obtain a good intrathoracic visual field using a da Vinci Xi surgical system (Intuitive Surgical Inc.) (5). But their method seems different from our original AA in that their method is basically the normal port placement with the camera and posterior port slightly higher, suggesting that the AA is a completely novel port placement technique.…”

Section: Original Articlementioning

confidence: 92%

Cumulative experience of the anterior approach in robot-assisted thoracic surgery for lung cancer patients

Yamazaki¹,

Toyokawa²,

Kozuma³

et al. 2021

J Thorac Dis

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Background: Robot-assisted thoracic surgery (RATS) lobectomy for lung cancer is now performed all around the world. The camera and robotic devices are generally inserted from a low position via the thorax.We previously reported our original anterior approach (AA) for performing RATS lobectomy with a camera and robotic devices inserted via the anterior chest wall. However, whether AA is comparable or superior to the conventional approach (CA) remains unclear. Methods: A total of 108 patients who underwent RATS lobectomy were included in the current study. We compared the AA with the CA for performing RATS lobectomy in terms of the operative and postoperative features, such as total operation/console time, blood loss and postoperative complications. Results: Eighty-seven and 21 patients underwent the AA and CA in RATS lobectomy, respectively. The console and total operation time were significantly shorter in the AA group than in the CA group for RATS lobectomy (median console time: AA vs. CA, 112 vs. 148 min, P=0.0001; median total operation time: AA vs.CA, 193 vs. 243 min, P=0.0002), especially left upper lobectomy. Intraoperative blood loss and the frequency of postoperative complications were significantly reduced in the AA group compared with the CA group (median intraoperative blood loss: AA vs. CA, 20 vs. 105 mL, P<0.0001; postoperative complications: AA vs. CA, 8.0% vs. 28.6%, P=0.0088). Conclusions: These results suggest that our AA of RATS lobectomy can be very easily and safely performed.

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“…On the other hand, some robotic surgeons certainly prefer OTVA. Yamazaki et al [ 11 ] and Funai et al [ 12 ] each described four-arm robotic approaches in which the patient’s craniocaudal direction can be viewed horizontally. In Yamazaki et al ’s anterior approach, the robotic instruments are always inserted from the ventral side of the patient’s thorax in both left- and right-side surgeries, and the left intrathoracic view is similar to that in our OTVA, whereas the right intrathoracic view is opposite to ours.…”

Section: Discussionmentioning

confidence: 99%

Emergency rollout and conversion procedures during the three-arm robotic open-thoracotomy-view approach

Nakada

Shirai

Takahara

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES To conduct robotic lung resections (RLRs) with views similar to those in open-thoracotomy surgery (OTS), we adopted a vertical port placement and confronting upside-down monitor setting: the robotic open-thoracotomy-view approach (OTVA). We herein discuss the procedures for emergency rollout and conversion from the robotic OTVA to OTS or video-assisted thoracoscopic surgery (VATS). METHODS We retrospectively reviewed the cases of 88 patients who underwent RLR with three-arm OTVA using the da Vinci Xi Surgical System between February 2019 and July 2021. Robotic ports were vertically placed along the axillary line, and 2 confronting monitors and 2 assistants were positioned on each side of the patient. Three possible conversions were prepared: (i) emergency thoracotomy using an incision along the ribs in a critical situation, (ii) cool conversion using vertical incision thoracotomy in a calmer condition and (iii) conversion to confronting VATS. All staff involved in the surgery repeatedly rehearsed the emergency rollout in practice. RESULTS No emergent or cool conversion to OTS occurred. Two patients (2.3%) experienced confronting VATS conversions. One patient underwent an urgent conversion for a moderate haemorrhage from a pulmonary artery branch during left upper lobectomy in the introduction phase. Another patient underwent a calmer conversion during an extended RS6 + S10a segmentectomy, where staples could not be inserted appropriately due to lung lacerations. In all patients, postoperative courses were uneventful. CONCLUSIONS The OTVA setting is a possible option for RLRs. This report describes the emergent rollout and subsequent conversion procedures for this method.

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Uniquely Modified Robotic-Assisted Thoracic Surgery With Good Intrathoracic Visual Field

Cited by 8 publications

References 2 publications

Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

Cumulative experience of the anterior approach in robot-assisted thoracic surgery for lung cancer patients

Emergency rollout and conversion procedures during the three-arm robotic open-thoracotomy-view approach

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