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Mordojovich G, Hugen N, Bottet B, Montagne F, Bouabdallah I, Pagès PB, Sarsam M, Thomas PA, Baste JM. New standardized five-zone lobectomy with structured assessment in robotic surgery: the French lobectomy. J Thorac Dis 2025; 17:2718-2729. [PMID: 40400940 PMCID: PMC12090120 DOI: 10.21037/jtd-24-1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 02/04/2025] [Indexed: 05/23/2025]
Abstract
The use of the robotic approach is rapidly increasing in thoracic surgery worldwide. Mastering this new technique is challenging and teaching robotic surgery is difficult. Nevertheless, to date, no academic certified training program including a standardized approach is available for robotic lobectomy and no objective assessment scale has been proposed. Here we describe new objective criteria for robotic lobectomy including a standardised surgical technique and an objective structured assessment scale to improve educational support for thoracic surgeons. The technique, referred to as the French lobectomy, is a standardized technique, and is based on five exposure and dissection zones. Each zone contains a number of dissection steps, which all together form a complete lobectomy. The technique can be applied to all lobectomies (and segmentectomies) for both the left and right side. In parallel, an objective structured assessment scale is designed to evaluate the performance of trainee surgeons who use the technique. This scale is based on five items with a minimum score of 5 points and a maximum score of 25 points. A conduct to follow based on the score obtained is proposed. This systematic and standardized robotic approach to lobectomies and its assessment scale, may allow surgeons and trainees to improve their technical skills and efficiency.
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Affiliation(s)
- Gerardo Mordojovich
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, Normandy, France
- Department of Surgery, Hospital Clínico Fuerza Aérea de Chile, Universidad Mayor, Santiago, Chile
- Department of Surgery, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Niek Hugen
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, Normandy, France
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Benjamin Bottet
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, Normandy, France
- UNIVROUEN, Normandy, Rouen University Hospital, Rouen, Normandy, France
| | - François Montagne
- Department of Thoracic Surgery, Valenciennes Hospital Center, Valenciennes, Hauts-de-France, France
| | - Ilies Bouabdallah
- Department of Thoracic Surgery, Saint Joseph Hospital, Marseille, Provence-Alpes-Côte d’Azur, France
| | - Pierre-Benoît Pagès
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, Bourgogne, France
| | - Mathieu Sarsam
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, Normandy, France
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Aix-Marseille University & APHM, Hôpital Nord, Marseille, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, Rouen University Hospital, Rouen, Normandy, France
- UNIVROUEN, Normandy, Rouen University Hospital, Rouen, Normandy, France
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Terra RM. Robotic thoracic surgery in Brazil. EINSTEIN-SAO PAULO 2024; 22:eEDS1. [PMID: 39570182 DOI: 10.31744/einstein_journal/2024eds1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024] Open
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3
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Bassiri A, Boutros C, Jiang B, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Adoption of Minimally Invasive Lung Resection: A National Cancer Database Study. J Surg Res 2024; 302:166-174. [PMID: 39098115 DOI: 10.1016/j.jss.2024.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/26/2024] [Accepted: 07/06/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Minimally invasive lung resection has been associated with improved outcomes; however, institutional characteristics associated with utilization are unclear. We hypothesized that the presence of surgical robots at institutions would be associated with increased utilization of minimally invasive techniques . METHODS Patients with cT1/2N0M0 non-small cell lung cancer who underwent lung lobectomy between 2010 and 2020 in the National Cancer Database were identified. Patients were categorized by operative approach as minimally invasive surgery (MIS) versus open. Institutions were categorized as "high utilizers" of MIS technique if their proportion of MIS lobectomies was >50%. Multivariate logistic regressions were used to determine factors associated with proportion of procedures performed minimally invasively. Further multivariate models were used to evaluate the association of proportion of MIS procedures with 90-d mortality, hospital length of stay, and hospital readmission. RESULTS In multivariate analysis, passage of time by year (odds ratio [OR] 1.26; confidence interval [CI] 1.22-1.30) and presence of a robot at the facility (OR 3.48; CI 2.84-4.24) were associated with high MIS-utilizing facilities. High utilizers of MIS were associated with lower 90-d mortality (OR 0.89; CI 0.83-0.97) and hospital length of stay (coeff -0.88; CI -1.03 to -0.72). Hospital readmission was similar between high and low MIS-utilizing facilities (compared to low MIS-utilizing facilities: OR 1.06; CI 0.95-1.09). CONCLUSIONS Passage of time and the presence of surgical robots were independently associated with increased utilization of MIS lobectomy. In addition to being associated with improved patient-level outcomes, robotic surgery is correlated with a higher proportion of procedures being performed minimally invasively.
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Affiliation(s)
- Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Christina Boutros
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Boxiang Jiang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Winter H, Eichhorn M, Eichhorn F, Grott M. [Modern individualized diagnostics and treatment of non-small cell lung cancer]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:280-287. [PMID: 38376521 DOI: 10.1007/s00104-024-02037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
Approximately one half of patients with non-small cell lung cancer (NSCLC) are diagnosed at resectable tumor stages (I-IIIA), which can potentially be curatively treated. In the early tumor stages (tumor diameter ≤2 cm) sublobar resection (segmentectomy or atypical wedge resection) leads to a 5‑year long-term survival comparable to lobectomy. The use of immunotherapy, especially within the framework of neoadjuvant treatment, is anticipated to change the surgical treatment of NSCLC in the future. With the introduction of lung cancer screening for certain risk groups in Germany planned for 2024, lung tumors can be expected to be diagnosed at earlier stages and more frequently curatively treated. This article provides an overview of the potential impact of lung cancer screening, modern minimally invasive surgical techniques and neoadjuvant treatment concepts for the surgical treatment of NSCLC.
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Affiliation(s)
- Hauke Winter
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland.
| | - Martin Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Florian Eichhorn
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
| | - Matthias Grott
- Thoraxchirurgie, Thoraxklinik Heidelberg, Roentgenstraße 1, 69126, Heidelberg, Deutschland
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Gamberini G, Maglio S, Mariani A, Mazzotta AD, Forgione A, Marescaux J, Melfi F, Tognarelli S, Menciassi A. Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation. Sci Rep 2024; 14:4779. [PMID: 38413654 PMCID: PMC10899586 DOI: 10.1038/s41598-024-55351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
The number of robot-assisted minimally invasive surgeries is increasing annually, together with the need for dedicated and effective training. Surgeons need to learn how to address the novel control modalities of surgical instruments and the loss of haptic feedback, which is a common feature of most surgical robots. High-fidelity physical simulation has proved to be a valid training tool, and it might help in fulfilling these learning needs. In this regard, a high-fidelity sensorized simulator of vascular structures was designed, fabricated and preliminarily validated. The main objective of the simulator is to train novices in robotic surgery to correctly perform vascular resection procedures without applying excessive strain to tissues. The vessel simulator was integrated with soft strain sensors to quantify and objectively assess manipulation skills and to provide real-time feedback to the trainee during a training session. Additionally, a portable and user-friendly training task board was produced to replicate anatomical constraints. The simulator was characterized in terms of its mechanical properties, demonstrating its realism with respect to human tissues. Its face, content and construct validity, together with its usability, were assessed by implementing a training scenario with 13 clinicians, and the results were generally positive.
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Affiliation(s)
- Giulia Gamberini
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Sabina Maglio
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Mariani
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessandro Dario Mazzotta
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Surgery, Madre Giuseppina Vannini Hospital, Istituto Figlie Di San Camillo, Rome, Italy
| | - Antonello Forgione
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | - Jacques Marescaux
- IRCAD France, Institut de recherche contre les cancers de l'appareil digestif, Strabourg Cedex, France
| | | | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arianna Menciassi
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
- The Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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Cao C, Fulham M, Irons J, Cooper W, Zhang O. Robotic Anatomical Pulmonary Resections: An Australian Experience. Heart Lung Circ 2024; 33:86-91. [PMID: 38065831 DOI: 10.1016/j.hlc.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Robotic thoracic surgery is a minimally invasive technique that allows the surgeon to perform delicate, accurate surgical manoeuvres within the chest cavity without rib spreading. Previous studies have suggested potential benefits of the robotic platform in nodal upstaging due to its versatility, seven degrees of freedom of movement, and superior vision. However, there is currently a paucity of robust clinical data from Australia. AIMS This study aimed to assess the perioperative safety and oncological efficacy of anatomical pulmonary resections performed using the robotic platform. Endpoints included mortality and major morbidity outcomes according to Clavien-Dindo classification and rate of pathological nodal upstaging compared with preoperative imaging using positron emission tomography. METHODS A single-surgeon retrospective analysis was performed using data collected from two institutions from July 2021 to May 2022, after ethics committee approval. Consecutive patients who underwent anatomical robotic resections were included in the study, with subsequent analysis of patients who had confirmed primary lung cancer. RESULTS A total of 52 patients underwent robotic anatomical pulmonary resection during the study period. Safety was demonstrated by 0% mortality and a 9.6% major complication rate, which was related to chest tube insertion for prolonged air leak or intensive care unit monitoring during treatment of atrial arrhythmia. After excluding patients who did not have primary lung cancer, 48 patients remained for further analysis; pathological nodal upstaging was observed in nine (18.8%) of these patients. On multivariate analysis, the total number of lymph nodes harvested was found to be a statistically significant predictor of nodal upstaging. Complete microscopic resection (R0) was achieved in 100% of patients. CONCLUSIONS This study represents the most extensive documentation of robotic thoracic procedures in Australia in the existing literature. It demonstrated a satisfactory safety profile with a relatively high rate of nodal upstaging, possibly reflecting the ability of the robotic instruments to perform comprehensive and complete nodal resection at the time of anatomical pulmonary resection.
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Affiliation(s)
- Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
| | - Michael Fulham
- University of Sydney, Sydney, NSW, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joanne Irons
- Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wendy Cooper
- University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Oscar Zhang
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
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7
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Tam JKC. Innovations in robotic platforms for uniportal thoracic surgery. J Thorac Dis 2023; 15:6385-6387. [PMID: 38249903 PMCID: PMC10797351 DOI: 10.21037/jtd-23-1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Affiliation(s)
- John Kit Chung Tam
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
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8
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Shanahan B, Galloway R, Stamenkovic S, Lau K, Waller D, Wilson H, Perikleous P. Thoracoscopic surgery in lung cancer: the rise of the robot. J Thorac Dis 2023; 15:5263-5267. [PMID: 37969288 PMCID: PMC10636456 DOI: 10.21037/jtd-23-1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023]
Affiliation(s)
| | - Richard Galloway
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | | | - Kelvin Lau
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | - David Waller
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
| | - Henrietta Wilson
- Department of Thoracic Surgery, St Bartholomew’s Hospital, London, UK
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9
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Eichhorn M, Rotärmel A, Haag J, Baum P, Winter H. [Robot-assisted Thoracic Surgery: Learning Curve and Cost Analysis in a German High-Volume Centre]. Zentralbl Chir 2023; 148:S26-S32. [PMID: 36108654 DOI: 10.1055/a-1921-9058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Robot-assisted thoracic surgery (RATS) is a rapidly evolving surgical technique in Europe. The aim of the study was to analyse the learning curve and safety during the establishment of a RATS-program at a high-volume thoracic surgery centre and to quantify the costs of the surgical procedure in Germany. Within a period of 33 months, 255 patients were prospectively enrolled in the study and all perioperative process times and complications were recorded. Mediastinal procedures were performed in 46%, anatomical lung resections in 38%, wedge resections in 7% and diaphragm plications in 6% of patients. The mean operating time was 130 min and the total length of stay was 7 days. The conversion rate was 3.2% and 30-day mortality 1.2%. Mean costs for surgical consumables per intervention amounted to 2,039 €; the average reimbursement was 9,568 €. In summary, RATS can be safely established, performed and trained with low complication rates and acceptable costs for consumables.
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Affiliation(s)
- Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Translational Lung Research Center Heidelberg, Heidelberg, Deutschland
| | - André Rotärmel
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Johannes Haag
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Philip Baum
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Translational Lung Research Center Heidelberg, Heidelberg, Deutschland
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10
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Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J, Acevedo-Rodríguez J, Dorado-Avila G, Osorio-Romero L, Chavez-Campos C, Acero-Alvarracín K. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus 2023; 15:e42370. [PMID: 37621804 PMCID: PMC10445506 DOI: 10.7759/cureus.42370] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.
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Affiliation(s)
| | | | | | - Luigi Pianetti
- General Surgery, Universidad Nacional del Litoral, Argentina, ARG
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Uniportal VATS for Diagnosis and Staging in Non-Small Cell Lung Cancer (NSCLC). Diagnostics (Basel) 2023; 13:diagnostics13050826. [PMID: 36899970 PMCID: PMC10001247 DOI: 10.3390/diagnostics13050826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Uniportal VATS has become an accepted approach in minimally invasive thoracic surgery since its first report for lobectomy in 2011. Since the initial restrictions in indications, it has been used in almost all procedures, from conventional lobectomies to sublobar resections, bronchial and vascular sleeve procedures and even tracheal and carinal resections. In addition to its use for treatment, it provides an excellent approach for suspicious solitary undiagnosed nodules after bronchoscopic or transthoracic image-guided biopsy. Uniportal VATS is also used as a surgical staging method in NSCLC due to its low invasiveness in terms of chest tube duration, hospital stay and postoperative pain. In this article, we review the evidence of uniportal VATS accuracy for NSCLC diagnosis and staging and provide technical details and recommendations for its safe performance for that purpose.
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Walji HD, Ellis SA, Martin-Ucar AE, Hernandez L. Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications. Front Surg 2023; 10:1146716. [PMID: 37206340 PMCID: PMC10189136 DOI: 10.3389/fsurg.2023.1146716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.
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Affiliation(s)
- Hasanali David Walji
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Steven Aaron Ellis
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Antonio Eduardo Martin-Ucar
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Luis Hernandez
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Correspondence: Luis Hernandez
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13
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Clinical Efficacy of Thoracoscopic Surgery with the da Vinci Surgical System versus Video-Assisted Thoracoscopic Surgery for Lung Cancer. JOURNAL OF ONCOLOGY 2022; 2022:5496872. [PMID: 35720224 PMCID: PMC9200580 DOI: 10.1155/2022/5496872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
Abstract
Objective To assess the clinical efficacy of thoracoscopic surgery with the da Vinci surgical system versus video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods From August 2019 to December 2020, 193 patients with lung cancer assessed for eligibility scheduled for surgery in our hospital were recruited and assigned at a ratio of 1 : 1 to receive VATS (control group) or thoracoscopic surgery with the da Vinci surgical system (research group). The primary measurement is the clinical efficacy of the two surgical modalities. Results The baseline features of the research group were comparable with those of the control group (P > 0.05). Besides, the two groups showed similar tumor types, tumor locations, and clinicopathological staging (P > 0.05). Da Vinci surgical system-assisted thoracoscopic surgery had short operative time, less intraoperative blood loss, better lymph node dissection, and lower intraoperative conversion rates compared to VATS. Compared with the control group, the research group had significantly higher postoperative forced expiratory volume in one second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), the functional assessment of cancer therapy-general module (FACT-G) of the FACT-lung (FACT-L) Chinese version V4.0, lung cancer-specific module scores, and total scores (P < 0.05). The research group showed better postoperative drainage volume, shorter intubation duration, and length of hospital stay and a lower incidence of complications versus the control group (P < 0.05). The da Vinci surgical system reduced the probability of intraoperative mistakes and better ensured a safe and satisfactory surgery. Conclusion The thoracoscopic surgery with the da Vinci surgical system better reduces intraoperative and postoperative bleeding, shortens drainage and intubation duration, enhances the lung function and survival quality of patients, and lowers the risk of surgical mistakes to ensure surgical safety versus VATS.
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Mangiameli G, Cioffi U, Testori A. Lung Cancer Treatment: From Tradition to Innovation. Front Oncol 2022; 12:858242. [PMID: 35692744 PMCID: PMC9184755 DOI: 10.3389/fonc.2022.858242] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Lung cancer (LC) is the second most commonly diagnosed cancer and the primary cause of cancer death worldwide in 2020. LC treatment is associated with huge costs for patients and society; consequently, there is an increasing interest in the prevention, early detection with screening, and development of new treatments. Its surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for early-stage non-small cell LC. In this article, we discuss the state of the art of thoracic surgery for surgical management of LC. We start by describing the milestones of LC treatment, which are lobectomy and an adequate lymphadenectomy, and then we focus on the traditional and innovative minimally invasive surgical approaches available: video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). A brief overview of the innovation and future perspective in thoracic surgery will close this mini-review.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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