Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
Instituto do Câncer do Estado de São Paulo, 251, Dr. Arnaldo Ave. Cerqueira César, São Paulo, SP, 01246-000, Brazil.
World J Surg. 2019 Nov;43(11):2920-2926. doi: 10.1007/s00268-019-05086-9.
In the last decade, robotic video-assisted thoracic surgery (R-VATS) has grown significantly and consolidated as an alternative to video-assisted thoracic surgery. The objective of this study is to present the implementation as well as the experience with R-VATS accumulated by 2 Brazilian groups. We also compared the outcomes of procedures performed during the learning curve and after a more mature experience.
Retrospective cohort study included all R-VATS procedures performed since April 2015 until April 2018. We describe the process of implantation of robotic surgery, highlighting the peculiarities and difficulties found in a developing country. Moreover, we reported our descriptive results and compared the first 60 patients to the subsequent cases.
Two hundred and five patients included 101 females/104 males. Mean age was 61.7 years. There were hundred and sixty-four pulmonary resections, 39 resections of mediastinal lesions, 1 diaphragmatic plication, and 1 resection of a hilar tumor. Median operative times were 205 min for lung resections and 129 min for mediastinal. There was no conversion to VATS or thoracotomy or major intraoperative complications. Median length of stay was 3 days for pulmonary resections and 1 day for mediastinal. Postoperative complications occurred in 35 cases (17.0%)-prolonged air leak was the most common (17 cases). One fatality occurred in an elderly patient with pneumonia and sepsis (0.4%). Comparison of the first 60 patients (learning curve) with subsequent 145 patients (consolidated experience) showed significant differences in surgical and ICU time, both favoring consolidated experience.
Our results were comparable to the literature. Robotic thoracic surgery can be safely and successfully implemented in tertiary hospitals in emerging countries provided that all stakeholders are involved and compromised with the implementation process.
在过去的十年中，机器人辅助电视胸腔手术（R-VATS）得到了显著发展，并成为电视胸腔手术的替代方法。本研究的目的是介绍 2 个巴西团队实施 R-VATS 的情况以及积累的经验。我们还比较了在学习曲线期间和更成熟经验后进行的手术的结果。
回顾性队列研究包括自 2015 年 4 月至 2018 年 4 月期间进行的所有 R-VATS 手术。我们描述了机器人手术的植入过程，强调了在发展中国家发现的特殊性和困难。此外，我们报告了我们的描述性结果，并将前 60 例患者与随后的病例进行了比较。
205 例患者包括 101 例女性/104 例男性。平均年龄为 61.7 岁。有 164 例肺切除术、39 例纵隔病变切除术、1 例膈肌折叠术和 1 例肺门肿瘤切除术。肺切除术的中位手术时间为 205 分钟，纵隔为 129 分钟。无中转开胸或电视胸腔镜手术或术中重大并发症。肺切除术的中位住院时间为 3 天，纵隔为 1 天。35 例（17.0%）发生术后并发症-最常见的是持续性漏气（17 例）。1 例老年患者因肺炎和败血症死亡（0.4%）。将前 60 例患者（学习曲线）与随后的 145 例患者（巩固经验）进行比较，手术和 ICU 时间均有显著差异，均有利于巩固经验。
我们的结果与文献相符。在新兴国家的三级医院中，只要所有利益相关者都参与并致力于实施过程，机器人胸部手术就可以安全且成功地实施。
