Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, London, UK.
Eur J Cardiothorac Surg. 2024 May 3;65(5). doi: 10.1093/ejcts/ezae139.
Robotic-assisted thoracoscopic surgery (RATS) facilitates complex pulmonary segmentectomy which offers one-stage diagnostic and therapeutic management of small pulmonary nodules. We aimed to explore the potential advantages of a faster, simplified pathway and earlier diagnosis against the disadvantages of unnecessary morbidity in benign cases.
In an observational study, patients with small, solitary pulmonary nodules deemed suspicious of malignancy by a multidisciplinary team were offered surgery without a pre or intraoperative biopsy. We report our initial experience with RATS complex segmentectomy (using >1 parenchymal staple line) to preserve as much functioning lung tissue as possible.
Over a 4-year period, 245 RATS complex segmentectomies were performed; 140 right: 105 left. A median of 2 (1-4) segments was removed. There was no in-hospital mortality and no requirement for postoperative ventilation. Complications were reported in 63 (25.7%) cases, of which 36 (57.1%) were hospital-acquired pneumonia. A malignant diagnosis was found in 198 (81%) patients and a benign diagnosis in 47 (19%). The malignant diagnoses included: adenocarcinoma in 136, squamous carcinoma in 31 and carcinoid tumour in 15. The most frequent benign diagnosis was granulomatous inflammation in 18 cases.
RATS complex segmentectomy offers a precise, safe and effective one-stop therapeutic biopsy in incidental and screen-detected pulmonary nodules.
机器人辅助胸腔镜手术（RATS）有助于进行复杂的肺段切除术，为小肺结节提供了一期诊断和治疗管理。我们旨在探讨更快、更简化的途径和早期诊断的潜在优势，以避免良性病例不必要的发病率。
在一项观察性研究中，多学科团队认为小的、单发的肺结节疑似恶性的患者被提供无需术前或术中活检的手术。我们报告了我们使用机器人辅助胸腔镜手术进行复杂肺段切除术（使用超过 1 个肺实质订书钉线）的初步经验，以尽可能保留更多的功能肺组织。
在 4 年期间，进行了 245 例 RATS 复杂肺段切除术；140 例右侧，105 例左侧。中位数切除 2（1-4）个段。无院内死亡，无需术后通气。63 例（25.7%）报告了并发症，其中 36 例（57.1%）为医院获得性肺炎。198 例（81%）患者的诊断为恶性，47 例（19%）为良性。恶性诊断包括：136 例腺癌、31 例鳞状细胞癌和 15 例类癌肿瘤。最常见的良性诊断是 18 例肉芽肿性炎症。
RATS 复杂肺段切除术为偶然和筛查发现的肺结节提供了精确、安全和有效的一站式治疗性活检。
