Cerfolio Robert J, Bess Kyle M, Wei Benjamin, Minnich Douglas J
Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Ann Thorac Surg. 2016 Aug;102(2):394-9. doi: 10.1016/j.athoracsur.2016.02.004. Epub 2016 Jun 22.
Our objective is to report our incidence, results, and technique for the control of major vascular injuries during minimally invasive robotic thoracic surgery.
This is a consecutive series of patients who underwent a planned robotic thoracic operation by one surgeon.
Between February 2009 and September 2015, 1,304 consecutive patients underwent a robotic operation (lobectomy, n = 502; segmentectomy, n = 130; mediastinal resection, n = 115; Ivor Lewis, n = 103; thymectomy, n = 97; and others, n = 357) by one surgeon. Conversion to thoracotomy occurred in 61 patients (4.7%) and in 14 patients (1.1%) for bleeding (pulmonary artery, n = 13). The incidence of major vascular injury during anatomic pulmonary resection was 2.4% (15 of 632). Of these, 13 patients required thoracotomy performed in a nonurgent manner while the injury was displayed on a monitor, 2 had the vessel repaired minimally invasively, 2 required blood transfusion (0.15%), and 1 patient had 30-day mortality (0.16%). Techniques used to minimize morbidity include having a sponge available during vessel dissection and stapling, applying immediate pressure, delaying the opening until the bleeding is controlled without external pressure, and ensuring there is no bleeding while the chest is opened.
Major vascular injuries can be safely managed during minimally invasive robotic surgery. Our evolving technique features initial packing of the bleeding for several minutes, maintaining calmness to provide time to prepare for thoracotomy, and reexamination of the injured vessel. If repair is not possible minimally invasively, the vessel is repacked and a nonhurried, elective thoracotomy is performed while the injury is displayed on a monitor to ensure active bleeding is not occurring.
我们的目的是报告在微创机器人辅助胸外科手术中控制主要血管损伤的发生率、结果及技术。
这是一组由一位外科医生连续进行计划中的机器人辅助胸外科手术的患者。
2009年2月至2015年9月，一位外科医生连续为1304例患者实施了机器人手术（肺叶切除术，n = 502；肺段切除术，n = 130；纵隔切除术，n = 115；艾弗·刘易斯手术，n = 103；胸腺切除术，n = 97；其他手术，n = 357）。61例患者（4.7%）中转开胸手术，14例患者（1.1%）因出血（肺动脉，n = 13）中转开胸。解剖性肺切除术中主要血管损伤的发生率为2.4%（632例中的15例）。其中，13例患者在损伤显示于监视器上时以非紧急方式进行了开胸手术，2例患者进行了微创血管修复，2例患者需要输血（0.15%），1例患者在30天内死亡（0.16%）。用于将发病率降至最低的技术包括在血管解剖和吻合时准备好海绵，立即施加压力，在不施加外部压力的情况下控制出血后再打开胸腔，以及确保打开胸腔时无出血。
在微创机器人手术中可以安全地处理主要血管损伤。我们不断发展的技术特点是最初对出血部位进行数分钟的填塞，保持冷静以便有时间准备开胸手术，并对受伤血管进行重新检查。如果无法进行微创修复，则对血管再次进行填塞，并在损伤显示于监视器上以确保无活动性出血时从容地进行择期开胸手术。
