Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Cardiothoracic Surgery, New York University Langone Health Center, New York, New York.
Ann Thorac Surg. 2019 May;107(5):1480-1486. doi: 10.1016/j.athoracsur.2018.11.059. Epub 2018 Dec 27.
Minimally invasive techniques are increasingly being used in pulmonary segmentectomy and combined subsegmentectomy. However, there are no reports as yet on robotic combined anatomic subsegmentectomy (CAS). In this report, we describe related clinical data and operative techniques and present our early results.
Clinical data of patients undergoing robotic CAS were retrospectively reviewed. A combined subsegmentectomy was defined as the resection of 2 or more subsegments that involved 2 or more adjacent segments. The study enrolled patients who underwent completely portal robotic CAS.
Between May 2015 and January 2018, a single surgeon performed completely portal robotic CAS for 16 patients. In the CAS-treated patients, 75% of the lesions were located in the right upper lobe, and none required conversion to thoracotomy. Median operative time was 175 minutes (range, 75 to 294 minutes), and mean postoperative hospital stay was 4 days (range, 2 to 11 days). Although 1 patient experienced a prolonged air leak, the other 15 recovered uneventfully. Within a median follow-up period of 15 months, there were no deaths or tumor recurrences.
Completely portal robotic CAS is a safe and effective procedure in a select subset of patients, proving quite suitable for smaller (<2 cm) multisegment lung cancers, particularly lesions of the right upper lobe. A robotics approach facilitates complex and challenging CAS, the disadvantage being lengthy operative times during early acquisition of skills.
微创技术越来越多地应用于肺段切除术和联合亚段切除术。然而，目前尚无关于机器人联合解剖性亚段切除术（CAS）的报道。在此报告中，我们描述了相关的临床数据和手术技术，并介绍了我们的初步结果。
回顾性分析接受机器人 CAS 治疗的患者的临床资料。联合亚段切除术定义为切除 2 个或更多累及 2 个或更多相邻段的亚段。该研究纳入了接受完全经端口机器人 CAS 的患者。
2015 年 5 月至 2018 年 1 月，一名外科医生为 16 名患者实施了完全经端口机器人 CAS。在接受 CAS 治疗的患者中，75%的病变位于右上叶，无一例需要转为开胸手术。中位手术时间为 175 分钟（75-294 分钟），术后平均住院时间为 4 天（2-11 天）。虽然 1 例患者发生长时间漏气，但其余 15 例均恢复顺利。中位随访 15 个月，无死亡或肿瘤复发。
在选择的患者亚组中，完全经端口机器人 CAS 是一种安全有效的手术方法，尤其适用于较小（<2 cm）的多段肺癌，特别是右上叶的病变。机器人方法有助于进行复杂和具有挑战性的 CAS，但缺点是在早期获得技能时手术时间较长。
