Two separate thoroscopic segmentectomies with vessel sealing system

Interlobar division using vessel-sealing system in robot-assisted pulmonary lobectomy

Objective

We investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy.

Methods

The medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division.

Results

The vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group.

Conclusions

We report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

Technological innovation in video-assisted thoracic surgery

The popularity of video-assisted thoracic surgery (VATS) which increased worldwide due to the recent innovations in thoracic surgical technics, equipment, electronic devices that carry light and vision and high definition monitors. Uniportal VATS (UVATS) is disseminated widely, creating a drive to develop new techniques and instruments, including new graspers and special staplers with more angulation capacities. During the history of VATS, the classical 10 mm 0° or 30° rigid rod lens system, has been replaced by new thoracoscopes providing a variable angle technology and allowing 0° and 120° range of vision. Besides, the tip of these novel thoracoscopes can be positioned away from the operating side minimize fencing with other thoracoscopic instruments. The curved-tip stapler technology, and better designed endostaplers helped better dissection, precision of control, more secure staple lines. UVATS also contributed to the development of embryonic natural orifice transluminal endoscopic surgery. Three-dimensional VATS systems facilitated faster and more accurate grasping, suturing, and dissection of the tissues by restoring natural 3D vision and the perception of depth. Another innovation in VATS is the energy-based coagulative and tissue fusion technology which may be an alternative to endostaplers.

Present and Future Application of Energy Devices in Thoracic Surgery

In the last decade, many energy devices have entered day-to-day practice in thoracic surgery. Some have proven and recognized applications, whereas others still require further trials. Nevertheless, currently used devices continue to be improved on and new applications for current devices will be evaluated. Ultimately, novel applications of energy in thoracic surgery and refinement in technology will hopefully allow for safer and less invasive techniques for patients requiring thoracic surgical procedures. In this article, we review the present and future applications of energy devices in thoracic surgery.