Paglialunga Pablo Luis, Molins Laureano, Guzmán Rudith, Guirao Angela, Grando Leandro, Sanchez-Lorente David, Guerrero Carlos, Bello Irene, Quiroga Nestor, Boada Marc
Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
Cir Esp (Engl Ed). 2023 Dec;101(12):833-840. doi: 10.1016/j.cireng.2023.04.020. Epub 2023 Aug 6.
Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery.
This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve.
During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104-178), mean chest tube duration was 0.9 days (0-2), and mean length of stay was 1.45 days (1-2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141-247), chest tube duration was 3.92 days (1-8), and length of stay was 4.6 days (1-8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered.
The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.
机器人辅助胸外科手术（RATS）是一项迅速发展的技术。在我们的研究中，我们旨在分析在我们胸外科采用机器人手术的过程结果。
这是一项对2021年1月至2022年3月在我院采用RATS方法连续进行手术的一系列患者的意向性分析。记录了患者特征、手术类型、手术时间、中转率、胸管留置时间、住院时间和并发症等数据。使用IBM SPSS®统计软件进行统计分析。对手术时间进行累积和分析以确定学习曲线。
在研究期间，51例患者接受了机器人手术，包括肺部和非肺部干预。此外，15例患者（29.4%）接受了非肺部干预：1例胸膜手术（2%）、2例膈肌手术（3.9%）和12例纵隔手术（23.5%）。在纵隔手术中，1例复杂血管畸形患者需要中转（8.3%），11例通过RATS完成，包括7例胸腺瘤（58.3%）、3例胸膜心包囊肿（25%）和1例神经源性肿瘤（8.3%）。平均手术时间为141分钟（104 - 178），平均胸管留置时间为0.9天（0 - 2），平均住院时间为1.45天（1 - 2）。36例患者接受了肺部手术（70.6%）。完整的RATS切除术（34例；94.4%）包括：3例楔形切除术（11.1%）、2例肺段切除术（3.7%）、28例肺叶切除术（81.5%）和1例袖状肺叶切除术（3.7%）。平均手术时间为194.56分钟（141 - 247），胸管留置时间为3.92天（1 - 8），住院时间为4.6天（1 - 8）。4例患者发生并发症（11.1%）。未记录到90天死亡率。
RATS的实施取得了良好的临床效果和适用于所有适应症的手术时间。在短时间内完成了快速学习曲线。既往电视辅助胸腔镜手术（VATS）经验、患者选择、团队培训和项目连续性是成功开展RATS项目的基础。
