Wang Yoyo, Randle Ryan J, Bhandari Prasha, He Hao, Trope Winston L, Guenthart Brandon A, Guo H Henry, Liou Douglas Z, Backhus Leah M, Berry Mark F, Shrager Joseph B, Lui Natalie S
University of Michigan Medical School, Ann Arbor, Mich.
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
JTCVS Open. 2024 May 28;20:202-209. doi: 10.1016/j.xjon.2024.05.011. eCollection 2024 Aug.
Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared with open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared with open and VATS approaches.
The cross-sectional area and density of bilateral rectus abdominis muscles were measured on computed tomography scans in patients who underwent lobectomy in 2018. The differences between the contralateral and ipsilateral muscles were compared between preoperative and 6-month surveillance scans. Changes were compared among the open, VATS, and robotic approaches through a mixed effects model after adjustments of correlation and covariates.
Of 99 lobectomies, 25 (25.3%) were open, 56 (56.6%) VATS, and 18 (18.1%) robotic. The difference between the contralateral and ipsilateral rectus muscle cross-sectional area was significantly larger at 6 months after robotic surgery compared with open (31.4% vs 9.5%, = .049) and VATS (31.4% vs 14.1%, = .021). There were no significant differences in the cross-sectional area between the open and VATS approach.
In this retrospective analysis, there was greater ipsilateral rectus muscle atrophy associated with robotic thoracic surgery compared with open or VATS approaches. These findings should be correlated with clinical symptoms and followed to assess for resolution or persistence.
机器人辅助胸外科手术是除电视辅助胸腔镜手术（VATS）之外的另一种微创方法，与开放手术相比，它产生的疼痛更少，恢复更快。然而，机器人手术切口通常放置得更低，这可能会增加影响腹壁的肋间神经损伤风险。我们假设与开放手术和VATS手术相比，机器人手术方法会导致同侧腹直肌萎缩更严重。
对2018年接受肺叶切除术的患者进行计算机断层扫描，测量双侧腹直肌的横截面积和密度。在术前和6个月的监测扫描之间比较对侧和同侧肌肉的差异。在调整相关性和协变量后，通过混合效应模型比较开放手术、VATS手术和机器人手术方法之间的变化。
在99例肺叶切除术中，25例（25.3%）为开放手术，56例（56.6%）为VATS手术，18例（18.1%）为机器人手术。与开放手术（31.4%对9.5%，P = .049）和VATS手术（31.4%对14.1%，P = .021）相比，机器人手术后6个月时，对侧和同侧腹直肌横截面积的差异明显更大。开放手术和VATS手术方法之间的横截面积没有显著差异。
在这项回顾性分析中，与开放手术或VATS手术相比，机器人辅助胸外科手术导致同侧腹直肌萎缩更严重。这些发现应与临床症状相关联，并进行随访以评估其缓解或持续情况。
