Igai Hitoshi, Ida Akinobu, Numajiri Kazuki, Nii Kazuhito, Kamiyoshihara Mitsuhiro
Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan.
Gen Thorac Cardiovasc Surg. 2025 Apr;73(4):245-253. doi: 10.1007/s11748-024-02081-3. Epub 2024 Sep 13.
We retrospectively evaluated whether or not conventional air leak testing is necessary in robotic major pulmonary resections.
After excluding patients who received 2 or more days of postoperative drainage for chylothorax or excessive pleural effusion, 578 patients who underwent major pulmonary resection using minimally invasive approaches between February 2019 and November 2023 at our institution were included in this study. All patients were divided into two groups including thoracoscopic (n = 471) and robotic (n = 107) approaches. Conventional air leak testing was performed in all patients in the thoracoscopic approach but not in the robotic approach. After propensity score matching of patient backgrounds between the two groups, perioperative outcomes were compared (n = 100 each). The primary endpoint was the rate of drain removal on postoperative day (POD) 2 or later. In addition, factors associated with drain removal on POD 2 or later in the robotic group were identified.
The rate of drain removal at POD 2 or later was not significantly different between the two groups (p = 0.011). Multivariable analysis to identify factors associated with drain removal at POD2 or later in the robotic approach showed that sealant application (p = 0.002) and lobectomy (vs. segmentectomy, p = 0.034) were significantly associated.
In conclusion, even in the absence of air leak testing, a robotic approach for major lung resections can result in a drain removal rate on the day of surgery or POD1 that is comparable to a conventional thoracoscopic approach. However, it may be useful in selected patients requiring sealant placement or undergoing lobectomy.
我们回顾性评估了在机器人辅助的大型肺切除术中常规漏气检测是否必要。
排除因乳糜胸或胸腔积液过多而接受术后2天或更长时间引流的患者后，本研究纳入了2019年2月至2023年11月在我院采用微创方法进行大型肺切除术的578例患者。所有患者分为两组，包括胸腔镜手术组（n = 471）和机器人手术组（n = 107）。胸腔镜手术组的所有患者均进行了常规漏气检测，而机器人手术组未进行。在对两组患者背景进行倾向评分匹配后，比较围手术期结果（每组n = 100）。主要终点是术后第2天或更晚拔除引流管的比率。此外，还确定了机器人手术组中与术后第2天或更晚拔除引流管相关的因素。
两组术后第2天或更晚拔除引流管的比率无显著差异（p = 0.011）。多变量分析用于确定机器人手术方法中与术后第2天或更晚拔除引流管相关的因素，结果显示使用密封剂（p = 0.002）和肺叶切除术（与肺段切除术相比，p = 0.034）与之显著相关。
总之，即使不进行漏气检测，机器人辅助的大型肺切除术在手术当天或术后第1天的引流管拔除率与传统胸腔镜手术相当。然而，对于需要放置密封剂或接受肺叶切除术的特定患者可能有用。
