Miyajima Masahiro, Maki Ryunosuke, Arai Wataru, Tsuruta Kodai, Shindo Yuma, Nakamura Yasuyuki, Watanabe Atsushi
Department of Thoracic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
J Thorac Dis. 2022 Jun;14(6):1890-1899. doi: 10.21037/jtd-21-1696.
The major advantages of robot-assisted surgery are the fine field of view provided by the high-precision three-dimensional (3D) images and the good operability provided by the robotic arms that enables precise movements. A growing number of retrospective studies have compared robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS), but the number of cases is limited and the results are contradictory.
We studied the medical records of primary lung cancer patients who underwent lobectomy with lymph node dissection between 2017 and 2020. Four hundred and eleven patients fulfilled the inclusion criteria in this study (RATS: 103; VATS: 308). We compared the perioperative factors and postoperative results of the VATS and RATS groups. Further, we adjusted background factors using propensity score matching (PSM) then compared the results of 200 patients (100 patients in each group). In this study, we matched interlobar fissure completeness, which affects operative difficulty and operative time; however, this has been superficially compared in previous studies.
After PSM, a significant difference was observed in the intraoperative blood loss (RATS: 53.3 mL, VATS: 120.3 mL, P=0.04). The rates of surgical complications were comparable between the groups (10.0% 13.0%, P=0.66) with similar mean operation times (RATS: 215.0 min, VATS: 210.1 min, P=0.57). The mean postoperative stay in the RATS group was shorter than that in the VATS group (10.0 11.5 days, P=0.04).
Initial experience of RATS had no obvious drawbacks when compared with that of VATS on propensity-matched analysis.
机器人辅助手术的主要优势在于高精度三维（3D）图像提供的精细视野以及机械臂提供的良好操作性，能够实现精确运动。越来越多的回顾性研究将机器人辅助胸腔镜手术（RATS）与电视辅助胸腔镜手术（VATS）进行了比较，但病例数量有限且结果相互矛盾。
我们研究了2017年至2020年间接受肺叶切除并淋巴结清扫的原发性肺癌患者的病历。本研究中有411例患者符合纳入标准（RATS组：103例；VATS组：308例）。我们比较了VATS组和RATS组的围手术期因素及术后结果。此外，我们使用倾向评分匹配（PSM）调整背景因素，然后比较200例患者（每组100例）的结果。在本研究中，我们匹配了影响手术难度和手术时间的叶间裂完整性；然而，此前的研究只是进行了表面比较。
PSM后，术中出血量存在显著差异（RATS组：53.3 mL，VATS组：120.3 mL，P = 0.04）。两组的手术并发症发生率相当（10.0%对13.0%，P = 0.66），平均手术时间相似（RATS组：215.0分钟，VATS组：210.1分钟，P = 0.57）。RATS组的术后平均住院时间短于VATS组（10.0天对11.5天，P = 0.04）。
在倾向评分匹配分析中，与VATS相比，RATS的初步经验没有明显劣势。
