Oh Daniel S, Tisol William B, Cesnik Larry, Crosby Anna, Cerfolio Robert J
Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Intuitive Surgical Inc., Sunnyvale, CA, USA.
Innovations (Phila). 2019 Nov/Dec;14(6):545-552. doi: 10.1177/1556984519883643. Epub 2019 Nov 19.
Robot-assisted lobectomy is the fastest growing technique for pulmonary lobectomy, but the diversity of approaches has led to apprehension about port placement among learning surgeons. The aim of this study was to survey high-volume thoracic surgeons who perform robot-assisted lobectomy to understand and consolidate common themes of port placement.
An electronic online survey was created, and the link was emailed to the 100 highest volume robotic thoracic surgeons in the United States. The survey included an interactive graphical interface, which allowed each respondent to mark the preferential robotic port placement in the chest wall for each of the 5 pulmonary lobectomies. Results were analyzed individually and in aggregate. A heat map was generated to show trends.
One hundred surgeons were surveyed (response rate: 62%). Most (90%) respondents utilized a 4-arm approach and 79% used a completely 4-arm portal approach with CO insufflation. Exact locations for each robotic port were reported by 60% of the surveyed surgeons and the results varied; however, most surgeons generally used the seventh to ninth interspaces for the camera and instruments. The use of multiple different interspace levels was common. Ninety-four percent of respondents used an additional nonrobotic assistant port.
There is not a universal port strategy for robot-assisted lobectomy. However, placement of the camera and robotic ports low in the seventh to ninth interspaces is the most common approach. There are some nuances of stapling port strategies and sequence of port placement, which are identified.
机器人辅助肺叶切除术是肺叶切除术中发展最快的技术，但手术入路的多样性让学习该技术的外科医生对端口放置感到担忧。本研究的目的是调查实施机器人辅助肺叶切除术的高年资胸外科医生，以了解并汇总端口放置的常见规律。
创建了一份电子在线调查问卷，并将链接通过电子邮件发送给美国100位手术量最高的机器人胸外科医生。该调查包括一个交互式图形界面，使每位受访者能够为5种肺叶切除术中的每一种标明在胸壁上优先放置机器人端口的位置。对结果进行了单独分析和汇总分析。生成了一张热图以显示趋势。
共调查了100位外科医生（回复率：62%）。大多数（90%）受访者采用四臂入路，79%使用完全四臂端口入路并进行二氧化碳充气。60%的受访外科医生报告了每个机器人端口的确切位置，结果各不相同；然而，大多数外科医生通常将摄像头和器械端口置于第七至第九肋间。使用多个不同肋间水平很常见。94%的受访者使用了一个额外的非机器人辅助端口。
机器人辅助肺叶切除术没有通用的端口策略。然而，将摄像头和机器人端口置于第七至第九肋间低位是最常见的方法。确定了一些吻合器端口策略和端口放置顺序的细微差别。
