Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
Salamanca Institute of Biomedical Research, Salamanca, Spain.
Eur J Cardiothorac Surg. 2024 Nov 4;66(5). doi: 10.1093/ejcts/ezae389.
Minimally invasive anatomic segmentectomy for the resection of pulmonary nodules has significantly increased in the last few years. Nevertheless, there is limited evidence on the safety and feasibility of robotic segmentectomy compared to video-assisted thoracic surgery. This study aimed to compare the real-world early outcomes of robotic and video-thoracoscopic surgery in anatomic segmentectomy.
Single-centre cohort study including all consecutive patients undergoing segmentectomy by either robotic or video-thoracoscopic from June 2018 to November 2023. Propensity score case matching analysis generated 2 matched groups undergoing robotic or video-thoracoscopic segmentectomy. Short-term outcomes were analysed and compared between groups.
204 patients (75 robotic and 129 video-thoracoscopic patients) were included. After matching, 146 patients (73 cases in each group) were compared. One 30-day death was observed in the robotic group (P = 1). Two conversions to thoracotomy occurred in the robotic, and none in the video-thoracoscopic group (P = 0.5). Surgical time was longer in the robotic group (P = 0.091). There were no significant differences between robotic and video-thoracoscopic groups in postoperative complications (13.7% vs 15.1%, P = 1), cardiopulmonary complications (6.8% vs 6.8%, P = 1), major complications (4.1% vs 4.1%, P = 1), prolonged air leak (4.1% vs 5.5%, P = 1), arrhythmia (1.4% vs 0%, P = 1) and reoperation (2.7% vs 2.7%, P = 1). Median length of stay was 3 days (interquartile range 2-3 days) in the robotic group vs 3 days (interquartile range 2.5-4 days) in the video-thoracoscopic group (P = 0.212).
Robotic segmentectomy is a safe and feasible alternative to video-thoracoscopy, as no significant differences in early postoperative outcomes were found between the 2 techniques.
微创解剖性肺段切除术在过去几年中显著增加。然而，与电视辅助胸腔镜手术相比，机器人肺段切除术的安全性和可行性的证据有限。本研究旨在比较机器人和电视胸腔镜手术在解剖性肺段切除术中的真实世界早期结果。
这是一项单中心队列研究，纳入了 2018 年 6 月至 2023 年 11 月期间行肺段切除术的所有连续患者，手术方式包括机器人或电视胸腔镜。采用倾向评分病例匹配分析生成 2 组接受机器人或电视胸腔镜肺段切除术的匹配组。分析并比较组间短期结果。
共纳入 204 例患者（75 例机器人组和 129 例电视胸腔镜组）。匹配后，146 例患者（每组 73 例）进行比较。机器人组有 1 例 30 天死亡（P=1）。机器人组有 2 例中转开胸，电视胸腔镜组无中转开胸（P=0.5）。机器人组的手术时间较长（P=0.091）。机器人组和电视胸腔镜组术后并发症（13.7%比 15.1%，P=1）、心肺并发症（6.8%比 6.8%，P=1）、主要并发症（4.1%比 4.1%，P=1）、长时间漏气（4.1%比 5.5%，P=1）、心律失常（1.4%比 0%，P=1）和再次手术（2.7%比 2.7%，P=1）发生率无显著差异。机器人组的中位住院时间为 3 天（四分位距 2-3 天），电视胸腔镜组为 3 天（四分位距 2.5-4 天）（P=0.212）。
机器人肺段切除术是电视胸腔镜的一种安全可行的替代方法，两种技术的术后早期结果无显著差异。
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