在成熟的视频辅助胸外科实践中尽早采用机器人肺切除术

IF 1.4 Q3 SURGERY
Ashley L. Deeb MD , Luis De Leon MD , Emanuele Mazzola PhD , Suden Kucukak MD , Anupama Singh MD , Miles McAllister BA , Matthew Garrity BS , Michael T. Jaklitsch MD , Jon O. Wee MD , Matthew M. Rochefort MD
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引用次数: 0

摘要

背景据报道,机器人胸腔镜手术的优点包括缩短住院时间(LOS)、改善淋巴腺切除术和减少并发症。目前还不确定在成熟的视频辅助胸腔镜(VATS)手术中引入机器人是否会带来这些优势。我们对这两种方法进行了比较,以研究这些优势。对 2016 年 5 月至 2018 年 12 月期间接受肺段切除术或肺叶切除术的患者进行 2:1(VATS:机器人)倾向匹配,并以年龄、性别、Charlson 合并指数、手术类型、分期、Exparel 和硬膜外作为协变量,使用加权逻辑回归进行比较。采用 Wilcoxon 秩和检验和 Rao-Scott Chi-squared 检验比较了并发症发生率、手术时间、取样淋巴结数量、疼痛程度、处置和住院时间。机器人手术的持续时间比 VATS 长(中位数 186 分钟(IQR 78)对 164 分钟(IQR 78.75);P < 0.001)。机器人取样的淋巴结(中位数 11 个(IQR 7.50)对 8 个(IQR 7.00);p = 0.004)和淋巴站(中位数 4 个(IQR 2.00)对 3 个(IQR 1.00);p <0.001)明显更多。有趣的是,机器人切除术的 72 小时疼痛评分(中位数 3 (IQR 3.25) vs. 2 (IQR 3.50);p = 0.04)和 48 小时阿片类药物用量(中位数 37.50 吗啡毫克当量 (MME) (IQR 45.50) vs. 22.50 吗啡毫克当量 (MME) (IQR 37.50);p = 0.01)更高。结论即使在成熟的 VATS 实践中,机器人方法也能更好地进行淋巴结取样。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early adoption of robotic lung resection in an established video assisted thoracic surgery practice

Background

Reported advantages to robotic thoracic surgery include shorter length of stay (LOS), improved lymphadenectomy, and decreased complications. It is uncertain if these benefits occur when introducing robotics into a well-established video-assisted thoracoscopy (VATS) practice. We compared the two approaches to investigate these advantages.

Materials and methods

IRB approval was obtained for this project. Patients who underwent segmentectomy or lobectomy from May 2016–December 2018 were propensity-matched 2: 1 (VATS: robotic) and compared using weighted logistic regression with age, gender, Charlson Comorbidity Index, surgery type, stage, Exparel, and epidural as covariates. Complication rates, operation times, number of sampled lymph nodes, pain level, disposition, and LOS were compared using Wilcoxon rank-sum and with Rao-Scott Chi-squared tests.

Results

213 patients (142 VATS and 71 robot) were matched. Duration of robotic cases was longer than VATS (median 186 min (IQR 78) vs. 164 min (IQR 78.75); p < 0.001). Significantly more lymph nodes (median 11 (IQR 7.50) vs. 8 (IQR 7.00); p = 0.004) and stations were sampled (median 4 (IQR 2.00) vs. 3 (IQR 1.00); p < 0.001) with the robot. Interestingly, robotic resections had higher 72-hour pain scores (median 3 (IQR 3.25) vs. 2 (IQR 3.50); p = 0.04) and 48-hour opioid usage (median 37.50 morphine milligram equivalents (MME) (IQR 45.50) vs. 22.50 MME (IQR 37.50); p = 0.01). Morbidity, LOS, and disposition were similar (all p > 0.05).

Conclusions

The robotic approach facilitates better lymph node sampling, even in an established VATS practice.

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