Rozhl Chir. 2023 Summer;102(5):199-203. doi: 10.33699/PIS.2023.102.5.199-203.
The initiation of lung cancer screening in Czechia and diagnosis in earlier stages has been reflected by an increasing demand for anatomical lung segmentectomy. The purpose of this study was to describe early results of the first robotic-assisted thoracoscopic segmentectomies performed in the country.
Our institution has performed 151 robotic anatomical lung resections since the initiation of the screening program in August 2020, which enabled us to attain the status of a proctoring and case observation centre. The robotic segmentectomy program was initiated after completing 70 robotic lobectomies. We performed a retrospective analysis of the results of our first 20 patients indicated for robotic segmentectomy.
Median age of the patients was 60, with 11 females and 7 males. The most common indications included primary lung malignancy (n=13), pulmonary metastasis (n=2) and benign lesions (n=3). We performed 11 simple segmentectomies, 6 complex (S2, S3, S1a+2, S10 on the right) and one right S6 segmentectomy with bronchoplasty. The mean number of harvested lymph nodes for NSCLC was 20, the mean blood loss was 25 mL (from 10 mL to 100 mL), and the mean operative time was 200 minutes. All resection margins were tumour-free. There was no conversion to thoracotomy. Two patients were excluded as they required conversion to robotic lobectomy given that their lesions were localized close to the intersegmental plane. One complication (recurrent laryngeal nerve paralysis) occurred in 1 patient. Mean chest tube duration was 1.9 days and length of stay 3.9 days.
Our experience suggests that implementation of the robotic segmentectomy program after completion of the robotic learning curve provides promising outcomes. Robotic technology and preoperative planning facilitate this technically demanding procedure especially when bronchoplasty is required.
捷克启动肺癌筛查并将诊断提前至早期阶段，这导致对解剖性肺段切除术的需求不断增加。本研究的目的是描述在该国首次开展的机器人辅助胸腔镜肺段切除术的早期结果。
自 2020 年 8 月启动筛查项目以来，我们机构已完成 151 例机器人解剖性肺切除术，这使我们获得了培训导师和病例观察中心的地位。在完成 70 例机器人肺叶切除术之后，我们启动了机器人肺段切除术项目。我们对前 20 例接受机器人肺段切除术的患者的结果进行了回顾性分析。
患者的中位年龄为 60 岁，其中女性 11 例，男性 7 例。最常见的适应证包括原发性肺癌（n=13）、肺转移瘤（n=2）和良性病变（n=3）。我们进行了 11 例单纯肺段切除术、6 例复杂肺段切除术（右肺 S2、S3、S1a+2、S10）和 1 例右肺 S6 段切除术伴支气管成形术。非小细胞肺癌的平均淋巴结清扫数目为 20 枚，平均出血量为 25 毫升（10 至 100 毫升），平均手术时间为 200 分钟。所有切缘均无肿瘤。无中转开胸。由于病变靠近段间平面，有 2 例患者需要转为机器人肺叶切除术而被排除在外。1 例患者发生 1 例并发症（喉返神经麻痹）。平均胸腔引流管留置时间为 1.9 天，住院时间为 3.9 天。
我们的经验表明，在完成机器人学习曲线后实施机器人肺段切除术项目可带来良好的效果。机器人技术和术前规划有助于完成这项技术要求较高的手术，特别是当需要支气管成形术时。
