Francis Jeevan, Domingues Diana Meirinho, Chan Jeremy, Zamvar Vipin
University of Edinburgh Medical School, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
Department of Cardiothoracic Surgery, Morriston Hospital, Swansea Bay University Health Board, Port Talbot, Wales, UK.
J Cardiothorac Surg. 2024 Oct 1;19(1):551. doi: 10.1186/s13019-024-03015-z.
Recent trials suggest that more conservative resections such as segmentectomy are non-inferior to more radical approaches. Most segmentectomy can be safely performed using video-assisted thoracoscopic surgery (VATS). The clinical benefits of robotic-assisted thoracoscopic surgery (RATS) remain unclear. We aimed to perform a systematic review evaluating the outcome of open thoracotomy, VATS, and RATS for segmentectomy.
A systematic database search was conducted of original articles exploring the outcome of open versus VATS versus RATS segmentectomy in PubMed, EMBASE and SCOPUS. The primary outcome was 30-day mortality. Secondary outcomes were hospital readmission, air leak, and post-operative pneumonia respectively.
11 studies were included with a total patient sample size of 7280. There were no differences between the three approaches in terms of 30-day mortality, hospital readmission, air leak, and post-operative pneumonia.
There are no significant differences between the three approaches in the clinical outcomes measured. While our analysis demonstrates the potential benefits of RATS, it is important to note that the steep learning curve associated with this technique may impact its wider adoption and efficacy in the community. Further randomised control studies are required to compare the short and long terms results of VATS and RATS approaches.
近期试验表明，诸如肺段切除术等更为保守的切除术并不逊色于更为激进的手术方法。大多数肺段切除术可通过电视辅助胸腔镜手术（VATS）安全实施。机器人辅助胸腔镜手术（RATS）的临床益处仍不明确。我们旨在进行一项系统评价，评估开胸手术、VATS和RATS行肺段切除术的结果。
在PubMed、EMBASE和SCOPUS中对探索开胸手术与VATS及RATS肺段切除术结果的原始文章进行系统数据库检索。主要结局是30天死亡率。次要结局分别是再次入院、漏气和术后肺炎。
纳入11项研究，患者样本总量为7280例。三种手术方法在30天死亡率、再次入院、漏气和术后肺炎方面无差异。
在所测量的临床结局方面，三种手术方法之间无显著差异。虽然我们的分析显示了RATS的潜在益处，但需要注意的是，与该技术相关的陡峭学习曲线可能会影响其在临床的更广泛应用及其疗效。需要进一步的随机对照研究来比较VATS和RATS手术方法的短期和长期结果。
