Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Ann Thorac Surg. 2014 Jul;98(1):203-8; discussion 208-9. doi: 10.1016/j.athoracsur.2014.02.051. Epub 2014 May 1.
The primary objective of this study was to evaluate our experience using a completely portal (no access incision) robotic pulmonary lobectomy or segmentectomy.
This was a retrospective review of a consecutive series of patients.
From February 2010 until October 2013, 862 robotic operations were performed by 1 surgeon. Of these, 394 were for a planned anatomic pulmonary resection, comprising robotic lobectomy in 282, robotic segmentectomy in 71, and conversions to open in 41 (10 for bleeding, 1 patient required transfusion; and no conversions for bleeding in the last 100 patients). Indications were malignancy in 88%. A median of 17 lymph nodes were removed. Median hospital stay was 2 days. Approximate financial data yielded: median hospital charges, $32,000 per patient (total, $12.6 million); collections, 23.7%; direct costs, $13,800 per patient; and $4,750 profit per patient (total, $1.6 million). Major morbidity occurred in 9.6%. The 30-day operative mortality was 0.25%, and 90-day mortality was 0.5%. Patients reported a median pain score of 2/10 at their 3-week postoperative clinic visit.
Robotic lobectomy for cancer offers outstanding results, with excellent lymph node removal and minimal morbidity, mortality, and pain. Despite its costs, it is profitable for the hospital system. Disadvantages include capital costs, the learning curve for the team, and the lack of lung palpation. Robotic surgery is an important tool in the armamentarium for the thoracic surgeon, but its precise role is still evolving.
本研究的主要目的是评估我们使用完全经端口（无入路切口）机器人肺叶切除术或肺段切除术的经验。
这是一项连续系列患者的回顾性研究。
自 2010 年 2 月至 2013 年 10 月，1 名外科医生共完成 862 例机器人手术。其中，394 例为计划进行解剖性肺切除术，包括 282 例机器人肺叶切除术、71 例机器人肺段切除术和 41 例转为开放性手术（10 例因出血，1 例需要输血；在最后 100 例患者中无出血转为开放性手术）。适应证为恶性肿瘤占 88%。中位数切除淋巴结 17 枚。中位住院时间为 2 天。近似财务数据显示：每位患者的中位住院费用为 32000 美元（总计 1260 万美元）；收费率为 23.7%；每位患者的直接费用为 13800 美元；每位患者的利润为 4750 美元（总计 160 万美元）。主要发病率为 9.6%。30 天手术死亡率为 0.25%，90 天死亡率为 0.5%。患者在术后 3 周的门诊就诊时报告中位数疼痛评分为 2/10。
机器人肺癌切除术治疗癌症可获得极佳的结果，具有出色的淋巴结清扫效果，且发病率、死亡率和疼痛均较低。尽管存在成本，但对医院系统来说是有利可图的。缺点包括资本成本、团队的学习曲线以及缺乏肺部触诊。机器人手术是胸外科医生的重要工具，但它的确切作用仍在不断发展。
