5945 Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital, New York, NY, USA.
Innovations (Phila). 2021 Mar-Apr;16(2):136-141. doi: 10.1177/1556984520978227. Epub 2021 Jan 15.
In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer.
This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups.
Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( < 0.01) and less estimated blood loss ( = 0.02). There were more lymph nodes harvested in the Robotic group ( = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities.
Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.
在机器人辅助微创手术的浪潮中，文献中机器人辅助肺切除术的病例较少。本研究评估了初始机器人入路行肺癌肺切除术的围手术期结果和转为开胸手术的风险因素。
这是一项 2015 年至 2019 年期间单中心回顾性研究，所有初始机器人入路行肺癌肺切除术的患者均纳入研究。患者分为两组：机器人辅助手术组和中转开胸手术组。比较两组患者的人口统计学、术前临床资料、手术病理和围手术期结果，以评估两组之间是否存在有意义的差异。
共 13 例患者接受了机器人肺切除术，其中 8 例完成了机器人手术，5 例中转开胸手术。两组患者的特征无显著差异。机器人组的手术时间更短（<0.01），估计出血量更少（=0.02）。机器人组的淋巴结清扫量更多（=0.08），但无统计学意义。机器人组有 2 例严重并发症，中转开胸组无并发症。肿瘤大小和分期均不能预测中转开胸手术。随着时间的推移，中转开胸手术的比例逐渐下降，其中大多数发生在最初的 2 年内。机器人组无出血并发症，无死亡病例。
机器人辅助肺癌肺切除术是一种安全的手术方法，是开胸手术的合理替代方法。通过精细的技术，可以避免大出血，大多数手术可以在机器人辅助下完成。需要进一步的大型研究来阐明机器人与开放手术相比的优势。
