Objective To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d.And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.
ObjectiveTo review the current status of da Vinci surgical system in vascular surgery. MethodsRecent literatures published in Chinese or English about the application of da Vinci surgical system in vascular surgery were reviewed and analyzed. Resultsda Vinci surgical system was mainly applied in diseases such as aortoiliac occlusive disease, aneurysm, typeⅡ endoleak after endovascular aortic repair, celiac artery compression syndrome, and so on. It was used to expose arteries, or assist to ligate and dissect arteries. da Vinci surgical system showed apparent advantages in shorting the time of aortic clamping, however, the high cost, the loss of tactile feedback, and the long learning curve may be its shortcomings. Conclusionda Vinci surgical system is safe and effective in vascular surgery, while much more experience is required to evaluate its long-term effect and complication.
Objective To investigate the clinical application of da Vinci surgical system in nipple sparing mastectomy (NSM) and immediate one-stage implant-based breast reconstruction. Methods Five cases of breast cancer who underwent NSM and immediate implant-based breast reconstruction were analyzed from March 2022 to April 2022. Evaluation endpoints included the key points of operation, duration of surgery, postoperative complications, and patient-reported outcomes. Results Two patients underwent implant-based postpectoral breast reconstruction without mesh. Three patients received prepectoral reconstruction with biological mesh, 2 of which underwent bilateral breast reconstruction. Operating duration of 5 patients was 240–320 min, with an average of 291 min. The blood loss was 10–30 mL, with an average of 18 mL. No patient switched to open surgery due to the uncontrolled bleeding. The average drainage volume was 78 mL/d (60–100 mL/d) in the first 3 days and 38 mL/d (30–50 mL/d) in the 3 to 7 days after operation. The drainage tube was removed 10–18 days after operation, with an average of 13.2 days. No postoperative infections or nipple-areolar complex necrosis were observed. The inpatient stay was 1–3 days, with an average of 1.8 days. One month after operation, the BREAST-Q satisfaction score was 64–82, with an average of 76.20. The average cost for operation was 45 072 RMB (43 420–47 524 RMB). Conclusions The robotic NSM and immediate one-stage implant-based breast reconstruction is a safe procedure with better clinical outcomes and favorable patients’ satisfaction. However, the robotic system has longer operation time and higher cost. It still needs to be personalized in the clinical practice.
ObjectiveTo summarize the clinical experience of 180 general surgeries under da Vinci surgical system. MethodsFrom January 2009 to October 2010, 180 patients with hepatopancreaticobiliary and gastrointestinal disease underwent robotic surgeries by using da Vinci surgical system. The case distribution, intra-and post-operative data were analyzed. ResultsA total of 171 patients had underwent total robotic surgeries and nine patients converted to hand-assisted procedure (5.0%, 9/180). The surgery for hepatic portal was performed in 63 cases of patients, including surgery for hilar cholangiocarcinoma in 36 cases, gallbladder carcinoma in 10 cases, complex calculus of intrahepatic duct in 12 cases, and iatrogenic biliary duct injury in 5 cases. The pancreatic surgery was performed in 44 cases of patients, including pancreatoduodenectomy in 16 cases, distal pancreatectomy in 6 cases, medial pancreatectomy in 1 case, pancreatic cyst-jejunum anastomosis in 1 case, and palliative surgery in 20 cases. Hepatic surgery was in 19 cases and gastrointestinal surgery in 12 cases of patients. Other procedures were in 42 cases of patients, including common bile duct exploration and removing the stone, retroperitoneal lymph nodes dissection, and splenectomy, etc. All of ten cases of patients with obstructive suppurative cholangitis received emergency surgery by the robot and postoperative infection symptoms were controlled, and shock was corrected quickly. No death occurred during the perioperative period. Postoperative complications occurred in 12 cases (6.7%, 12/180) and 2 cases died (1.1%, 2/180). Conclusionsda Vinci surgical system can carry out all kinds of general surgery, especially complicated and difficult hepatobiliary and pancreatic surgery, which improves the development of minimally invasive surgery.
Objective To investigate the application of enhanced recovery after surgery (ERAS) in da Vinci robotic McKeown surgery for esophageal cancer. Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed. According to the treatment, they were divided into two groups, a conventional group and an ERAS group. Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery, and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode. Relevant hospitalization indicators and postoperative complication rates were compared between the two groups. Results Finally 128 patients were collected, including 106 males and 22 females, with an average age of 61.91 years. There were 71 patients in the conventional group and 57 patients in the ERAS group. The postoperative pain index in the ERAS group was significantly lower than that in the conventional group (P<0.05), and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group (2.39±0.49 d vs. 3.13±0.63 d, P<0.001). There was no statistical difference in the incidence of postoperative related complications (gastroesophageal reflux, anastomotic stenosis, anastomotic fistula, arrhythmia, recurrent laryngeal nerve injury, chylothorax, anastomosis stomatitis or incisional infection) between the two groups (P>0.05), but the incidence of postoperative lung infection in the ERAS group was statistically lower (12.28% vs. 26.76%, P=0.043), and the volume of postoperative pleural effusion was statistically less compared with the conventional group (P<0.05). In the ERAS group, the surgery time (294.35±15.19 min vs. 322.79±59.09 min, P<0.001), postoperative exhaust time (1.44±0.39 d vs. 1.94±0.43 d, P<0.001), postoperative removal time of nasolasal tube (6.79±0.73 d vs. 8.21±0.86 d, P<0.001), hospital stay (19.88±3.36 d vs. 21.34±3.59 d, P=0.020), hospitalization costs (105 575.28±8 960.75 yuan vs. 137 894.64±19 518.60 yuan, P<0.001) were all lower or shorter than those of the conventional group. Postoperative activity was longer in the ERAS group than that in the conventional group (P<0.05), but there was no statistical difference in preoperative anesthesia time between the two groups (P=0.841). Conclusion The application of ERAS in da Vinci robotic McKeown surgery for esophageal cancer can effectively alleviate the physiological and psychological burden of patients, reduce the occurrence of postoperative related complications, effectively shorten the total hospital stay, save hospitalization costs, and reduce the economic burden of patients and society. Therefore, it can be promoted and applied in the clinic.
ObjectiveTo explore the application value of prognostic nutritional index (PNI) in the postoperative complications of McKeown surgery for da Vinci robotic esophageal cancer. MethodsThe clinical data of the patients who underwent da Vinci robotic McKeown surgery for esophageal cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2019 to June 2022 were retrospectively collected. According to the receiver operating characteristic (ROC) curve, the optimal cut-off value of PNI for predicting postoperative complications was explored. The patients were divided into a high PNI group and a low PNI group according to the cut-off value, and the differences in basic characteristics, surgery-related indexes and postoperative complications between the two groups were analyzed. According to the occurrence of postoperative complications, the patients were divided into a non-complication group and a complication group. Univariate and multivariate analyses were used to explore the influence of relevant indicators on the occurrence of postoperative complications in da Vinci robotic McKeown surgery for esophageal cancer. ResultsFinally 120 patients were collected, including 95 males and 25 females, with an average age of 62.82 years. The preoperative hemoglobin content, preoperative blood lymphocyte count, preoperative serum albumin and preoperative blood total cholesterol in the high PNI group were higher than those in the low PNI group (P<0.05). There were statistical differences between the two groups in the incidences of postoperative overall complications, pulmonary infection, pleural effusion and poor incision healing (P<0.05). The relevant indicators that may cause postoperative complications were included in univariate analysis, and the results showed that age, operation time, intraoperative blood loss, preoperative blood lymphocyte count, preoperative hemoglobin content, preoperative blood mononuclear cell count, preoperative blood monocyte count, serum albumin level and PNI were possible influencing factors of postoperative complications after da Vinci robotic McKeown surgery for esophageal cancer. Incorporating these influencing factors into multivariate analysis, the results showed that age, PNI, operation time and intraoperative blood loss were independent influencing factors of postoperative complications. ConclusionPNI has certain predictive value in the postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer. PNI is an independent factor affecting postoperative complications. Improving the level of PNI in esophageal cancer patient before surgery may help reduce the occurrence of postoperative complications.
ObjectiveTo summarize the surgical learning curve and evaluate the effectiveness, safety and feasibility of the robotic-assisted thoracoscopic surgery (RATS) by comparing with the conventional vedio-assisted thoracoscopic surgery (VATS).MethodsThe clinical data of 40 patients receiving robotic assisted thoracoscopic anatomic lung resection from March to June 2016 in our department were reviewed. There were 29 males and 11 females with the age of 54-78 (60.2±12.7) years in the RATS group, and 27 males and 10 females with the age of 52-76 (58.7±11.5) years in the VATS group. Lung space-occupying lesions were comfirmed by preoperative diagnosis. The operative time, blood loss, chest tube retention time, postoperative hospital stay and perioperative morbidity and mortality were analyzed. The safety and feasibility were evaluated, and the learning curve was summed up.ResultsOperative time, postoperative ventilation time, intraoperative blood loss, chest tube retention time, postoperative pain, average hospital stay, postoperative complication rate between two groups were not statistically significant. In the RATS group preoperative preparation time was longer than that of the VATS group (24.5 min vs. 15.6 min, P=0.003), and the rate of conversion to thoracotomy of the RATS group was lower than that of the VATS group (0 vs. 10.8%). There was no perioperative death in two groups.ConclusionRobotic-assisted thoracic surgery is safe and effective in the early learning process, and the learning curve can be entered into the standard stage from the learning stage after initial 10 operations.
Objective To investigate the learning curve for da Vinci robot-assisted mediastinal tumor resection (DRMTR). Methods A total of 50 consecutive patients received DRMTR between March 2011 and September 2012 in our hospital. Clinical data of the 50 patients were collected and analyzed. There were 23 males, 27 females aged 46.9(17–80) years. The learning curve was evaluated by using the cumulative sum (CUSUM) analysis. Results The mean operation time was 124.6 min. The CUSUM learning curve was best modeled as a third-order polynomial curve with the equation: CUSUM=0.046×case-number3–4.681×case-number2+127.508×case-number–237.940, which had a highR2 value of 0.868. The fitting curve reached the top after the 19th case, which suggested that the surgeons master the technique after they finished 19 cases. As a cut-off point, the 19th case divided the learning curve into two phases, in which there was statistical diffference in operation time (P<0.01), intraoperative blood loss (P<0.01), the postoperative duration of chest tube drainage (P<0.01 ) and the rate of postoperative complications (P<0.05 ). Conclusion The DRMTR identified by CUSUM analysis represents two characteristic stages of DRMTR: the learning stage and the mastery stage. It is suggested from our data that the surgeons need finish about 19 cases to master DRMTR.
ObjectiveThrough the perioperative outcome analysis of da Vinci robot-assisted sleeve lobectomy, to clarify its efficacy and safety.MethodsA retrospective analysis was performed on 10 patients with centrally located lung cancer undergoing robot-assisted sleeve lobectomy from March to December 2019 in our center, including 9 males and 1 female, aged 45-67 (55.0±8.9) years. Preoperative imaging and bronchoscopy showed central non-small cell lung cancer, involving the right upper lung in 3 patients, right lower lung in 2 patients, the left upper lung in 4 patients, and left lower lung in 1 patient. The operation time, Docking time, intraoperative blood loss volume, bronchial anastomosis time, number of dissected lymph nodes, drainage volume and postoperative hospital stay were analyzed.ResultsThe da Vinci robot-assisted bronchial sleeve lobectomy was completed smoothly on 10 patients. The operation time was 135-183 (157.8±14.3) min, Docking time 6-15 (10.0±2.9) min, intraoperative blood loss volume 55-250 (124.5±61.8) mL, bronchial anastomosis time 17-40 (27.7±7.3) min, the number of dissected lymph nodes 16-23 (19.7±2.8), the drainage volume 200-600 (348.0±148.4) mL and postoperative hospital stay 7-11 (8.7±1.6) d. All patients had no bronchopleural fistula, pulmonary infection or atelectasis, and there was no perioperative death. Postoperative pathological findings were all squamous cell carcinoma.ConclusionDa Vinci robot-assisted sleeve lobectomy is safe and effective.
Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery (VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results There was no statistical difference in surgery time between the two groups (t=–0.365, P=0.681). Less intraoperative blood loss (t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery (t=–6.325, P=0.045), shorter period of bearing drainage tubes after surgery (t=–1.687, P=0.024), shorter hospital stays (t=–3.689, P=0.021), lower visual analogue scale (VAS) scores of postoperative 48 hours (t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.