Zhou Zhenyu, Wang Zhitian, Zheng Zhelan, Cao Jinlin, Zhang Chong, He Zhehao, Lv Wang, Hu Jian
Department of Thoracic Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Ultrasound Imaging, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Med Ultrason. 2017 Nov 29;19(4):374-379. doi: 10.11152/mu-1053.
Robotic-assisted thoracic surgery (RATS) has become a promising treatment for pulmonary neoplasms. During RATS, intraoperative ultrasonography can act as an "alternative finger" to "touch" and locate lesions, especially pulmonary nodules. This study was aimed to investigate the efficacy of intraoperative ultrasonographic localization during da Vinci RATS procedures.
Patients with pulmonary nodules were randomly divided into an Experimental Group and Control Group in which nodules were respectively located using intraoperative ultrasonography or by the surgeon's anatomic knowledge. The success rates and relevant localization factors were compared between the groups and analyzed to conclude the efficacy of intraoperative ultrasonography. Additionally, the intraoperative ultrasonography learning curve was analyzed to evaluate each surgeon's ability to independently perform intraoperative ultrasonography.
Thirty-four patients were included in the study (n = 17/group). Respectively, the Experimental Group and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had average ages of 55.5 and 55.8 years. In the Experimental group, ultrasonographic localization for mixed ground-glass nodules with CT values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By contrast, the localization efficacy in Control Group was 20.0% (p=0.032).A single surgeon without prior experience performed intraoperative ultrasonography in 20 cases, and the latter 10 procedures required significantly less time relative to the former 10 procedures (p=0.000).
During RATS, the use of intraoperative ultrasonography as an "alternative finger" to "touch" and findthe accurate location of pulmonary nodules, especially mixed ground-glass nodules, is warranted.
机器人辅助胸腔镜手术（RATS）已成为治疗肺部肿瘤的一种有前景的方法。在RATS手术中，术中超声可作为“替代手指”来“触摸”和定位病变，尤其是肺结节。本研究旨在探讨达芬奇RATS手术中术中超声定位的疗效。
将肺结节患者随机分为实验组和对照组，分别采用术中超声或术者的解剖学知识定位结节。比较两组的成功率及相关定位因素，并进行分析以得出术中超声的疗效。此外，分析术中超声的学习曲线以评估每位术者独立进行术中超声检查的能力。
本研究共纳入34例患者（每组17例）。实验组和对照组女性分别占41.2%和58.9%（p = 0.937），平均年龄分别为55.5岁和55.8岁。在实验组中，CT值为-500至-100亨氏单位的混合磨玻璃结节的超声定位有效率为87.5%。相比之下，对照组的定位有效率为20.0%（p = 0.032）。一名无既往经验的术者对20例患者进行了术中超声检查，后10例手术所需时间明显少于前10例手术（p = 0.000）。
在RATS手术中，使用术中超声作为“替代手指”来“触摸”并找到肺结节，尤其是混合磨玻璃结节的准确位置是可行的。
