Robotic thoracic surgery: lessons learned from the first 1,000 procedures

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-09-12 DOI:10.3389/fsurg.2024.1417787

Marion Durand, Lee S. Nguyen, Frankie Mbadinga, Maksim Pryshchepau, Hadrien Portefaix, Nouha Chaabane, Stanislas Ropert, Naziha Khen-Dunlop

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Abstract

IntroductionThe aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.MethodsIn a single-center subset of the Epithor® database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann–Whitney–Wilcoxon test for continuous variables. Tests were considered significant for a p-value <0.05.ResultsRobotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9 ± 7 vs. 7 ± 5.6 days, p < 0.001), a shorter surgery time (99 ± 24 vs. 116 ± 38 min, p < 0.001) a lower conversion rate (n = 2 vs. n = 17, p = 0.004), and a lower complication rate (28% vs. 40%, p = 0.009, mainly Clavien–Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, p < 0.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%/20% to 30%/70% over the 9 years.DiscussionA robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.

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机器人胸腔手术：从最初的 1,000 例手术中汲取的经验教训

方法在法国胸外科前瞻性队列数据库 Epithor® 数据库的单中心子集中，我们分析了 2014 年 2 月至 2023 年 4 月期间的手术特征和临床结果。肺部手术采用四臂胸腔闭合式手术技术，采用端口入路，血管缝合和打结优于缝合。对不连续变量采用Chi-2检验，对连续变量采用Mann-Whitney-Wilcoxon检验进行统计分析。P值为<0.05的检验被认为是有意义的。结果85%的病例在解剖肺切除术中使用了机器人胸腔镜手术。在研究期间，1,067 名患者接受了机器人手术，其中 509 人进行了肺叶切除术，391 人进行了肺段切除术。在分段切除术组与肺叶切除术组中，我们观察到住院时间更短（9±7天 vs. 7±5.6天，pamp &;lt;0.001），手术时间更短（99±24分钟 vs. 116±38分钟，pamp &;lt;0.001），转换率更低（n = 2 vs. n = 17，p = 0.004），并发症发生率更低（28% vs. 40%，p = 0.009，主要是Clavien-Dindo II，分别为18%和28%）。在癌症治疗手术方面，我们发现分段切除术组的既往癌症发生率更高（48% 对 26%，p < 0.001）。讨论机器人平台是进行肺部解剖切除术的合适工具，尤其适用于开发安全、系统的保肺肺叶下切除术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.