Analysis of First 50 Robotic-Assisted Thoracic Surgeries in a University Teaching Hospital: Anesthetic Considerations and Postoperative Outcomes.

Abstract

Introduction: Robotic-assisted thoracic surgery (RATS), due to its multiple advantages, has revolutionized the medical field in recent years. Yet, its implementation has been slower compared to other surgical fields. More data on the benefits of RATS regarding patient outcomes are required to justify the high costs of equipment. This study aimed to expand our understanding of anesthetic management of RATS and to analyze the postoperative patient outcomes.

Materials and methods: The r-retrospective descriptive study of the clinical history of 50 patients who underwent RATS using Da Vinci dVX® between 2018 and 2021 in the Thoracic Surgery Department of a single-center university teaching hospital. Statistical analyses of the clinical-demographic variables and those related to airway management, mechanical ventilation, intraoperative hemodynamics, and postoperative outcomes were carried out. Subgroup analysis of patient cases was performed based on the date of surgical intervention to compare the operating time, length of hospital stay, and postoperative complications as surrogates of the learning curve.

Results: 92% of patients were easily intubated with double-lumen tubes (76% were VivaSight-DL and 12% standard double-lumen tubes) following the usual protocol, while in 8% of patients, a difficult airway was detected and lung isolation using bronchial blockers was performed. During the one-lung ventilation (OLV) period, 24.4% of patients suffered arterial hypotension and 19.5% required intravenous vasoconstrictors probably due to the capnothorax. The mean duration of the interventions was 135.4 minutes. The average hospital stay was 5.4 days on average, and the mean number of complications was 0.48% per person. No statistically significant difference was found between early and late patient subgroups in terms of operating time, length of hospital stay, and postoperative complications.

Conclusions: RATS is a safe intervention which is well managed anesthetically by the use of double-lumen tubes with embedded camera. The use of protective ventilation strategy, including optimal PEEP and lung recruitment maneuver, during one-lung ventilation is effective and hemodynamically well-tolerated in the majority of the patients (80%). The RATS approach is associated with short hospital stay and low postoperative complication incidence. Further studies are warranted to explore new anesthetic management techniques and compare the benefit of robot-assisted thoracic surgery with conventional surgical approaches.