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Boeken T, Lim HPD, Cohen EI. The Role and Future of Artificial Intelligence in Robotic Image-Guided Interventions. Tech Vasc Interv Radiol 2024; 27:101001. [PMID: 39828389 DOI: 10.1016/j.tvir.2024.101001] [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] [Indexed: 01/22/2025]
Abstract
Artificial intelligence and robotics are transforming interventional radiology, driven by advancements in computer vision, robotics and procedural automation. Historically focused on diagnostics, AI now also enhances procedural capabilities in IR, enabling future robotic systems to handle complex tasks such as catheter manipulation or needle placement with increasing precision and reliability. Early robotic systems in IR demonstrated improved accuracy in both vascular and percutaneous interventions, though none were equipped with automatic decision-making. This review tends to show the potential in improving procedural outcomes with AI for robotics, though challenges remain. Techniques like reinforcement learning and haptic vision are under investigation to address several issues, training robots to adapt based on real-time feedback from the environment. As AI-driven robotics evolve, IR could shift towards a model where human expertise oversees the technology rather than performs the intervention itself.
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Affiliation(s)
- Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, AP-HP; Université Paris Cité, Faculté de Médecine; HEKA INRIA, INSERM PARCC U 970, Paris, France
| | - Hwa-Pyung David Lim
- Department of Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - Emil I Cohen
- Department of Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC.
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Duan X, He R, Jiang Y, Cui F, Wen H, Chen X, Hao Z, Zeng Y, Liu H, Shi J, Cheong H, Dong M, U K, Jiang S, Wang W, Liang H, Liu J, He J. Robot-assisted navigation for percutaneous localization of peripheral pulmonary nodule: an in vivo swine study. Quant Imaging Med Surg 2023; 13:8020-8030. [PMID: 38106331 PMCID: PMC10721995 DOI: 10.21037/qims-23-716] [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: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 12/19/2023]
Abstract
Background Robot-assisted surgery (RAS) systems have been developed but rarely applied to lung nodule localization. This study aimed to assess the feasibility and safety of using a robot-assisted navigation system in percutaneous lung nodule localization. Methods A computed tomography (CT)-guided robot-assisted navigation system was used to localize the simulated peripheral nodule in the swine lung through fluorescent agent injection. After the localization, fluorescent thoracoscopic wedge resection was performed. The deviation between the target point and the needle tip was measured using a professional 3-dimensional (3D) distance measurement software. The primary outcome was the localization accuracy (deviation) of the localization. The secondary outcomes were the localization-related complication rate, the localization duration, and the success rate. Results A total of 4 pigs were enrolled, and 20 peripheral lung nodules were created and localized successfully. All nodules underwent subsequent wedge resection for verification. The mean deviation by measuring the 3D distance was 3.81 mm [standard deviation (SD): 1.29 mm, 95% confidence interval (CI): 2.936-4.536 mm]. The technical success rate for localization was 100%, and the mean localization time was 14.69 minutes (SD: 4.67 minutes). The complication rate was 5% (1/20), with 1 pneumothorax after localization, and no mortality occurred. Conclusions This pilot animal study demonstrated the promising potential of the robot-assisted navigation technique in peripheral lung nodule localization, with high accuracy and feasibility. Further clinical trials are needed to validate its safety compared to traditional manual localization.
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Affiliation(s)
- Xingguang Duan
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Rui He
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Yu Jiang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hao Wen
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | | | - Zhexue Hao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yuan Zeng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jipeng Shi
- True Health Medical Technology Co. Ltd., Hengqin, China
| | - Houiam Cheong
- True Health Medical Technology Co. Ltd., Hengqin, China
| | - Mengxing Dong
- True Health Medical Technology Co. Ltd., Hengqin, China
| | | | - Shunjun Jiang
- Departments of Pharmacology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- Southern Medical University, Guangzhou, China
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Paglialunga PL, Molins L, Guzmán R, Guirao A, Grando L, Sanchez-Lorente D, Guerrero C, Bello I, Quiroga N, Boada M. Starting a robotic thoracic surgery program: From wedge resection to sleeve lobectomy in six months. Initial conclusions. Cir Esp 2023; 101:833-840. [PMID: 37544607 DOI: 10.1016/j.cireng.2023.04.020] [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: 10/20/2022] [Accepted: 04/08/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. METHODS This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. RESULTS During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104-178), mean chest tube duration was 0.9 days (0-2), and mean length of stay was 1.45 days (1-2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141-247), chest tube duration was 3.92 days (1-8), and length of stay was 4.6 days (1-8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. CONCLUSIONS The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.
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Affiliation(s)
- Pablo Luis Paglialunga
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Laureano Molins
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rudith Guzmán
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Angela Guirao
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Leandro Grando
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - David Sanchez-Lorente
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Guerrero
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Irene Bello
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Nestor Quiroga
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marc Boada
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
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Wang H, Wu Y, Huang P, Chen W, Wang Z, Wang Y. Comparison of effectiveness and safety of Da Vinci robot's "3 + 1" and "4 + 1" modes of treatment for colorectal cancer. J Robot Surg 2023; 17:2807-2815. [PMID: 37735326 DOI: 10.1007/s11701-023-01717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
To compare the effectiveness of the Da Vinci Surgical Robot System (DSRS) "3 + 1" and "4 + 1" models for colorectal cancer (CRC). A total of 107 patients with CRC admitted to our hospital from February 2021 to May 2022 were selected for the retrospective analysis. Of these, 57 patients underwent the DSRS "4 + 1" model (control group), while the rest 50 underwent the DSRS "3 + 1" model (research group). The operation time, intraoperative bleeding, number of lymph nodes detected, time of first postoperative urinary catheter removal, time of first feeding, time of first venting and hospitalization were compared between the two groups. The changes of white blood cell (WBC) and C-reactive protein (CRP) levels before and after surgery were detected, and patients' adverse effects and treatment costs between surgery and hospital discharge were counted. The Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) were used to assess the psychological state of the patients. There was no difference in operative time, intraoperative bleeding, and number of lymph nodes detected between both groups (P > 0.05), while time to first postoperative urinary catheter removal, time to first feeding, time to first venting, length of stay (LOS), postoperative inflammatory factor levels, incidence of adverse events, and treatment costs were all lower in the research group than in the control group (P < 0.05). SAS and SDS scores decreased after treatment in both groups, but the decrease was more obvious in the research group (P < 0.05). Both DSRS "4 + 1" and "3 + 1" modes have better treatment effects for CRC. However, the "3 + 1" mode has higher safety and lower treatment cost, which can significantly improve the postoperative recovery process of patients and is more worthy to be promoted in clinical practice.
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Affiliation(s)
- Huaiwen Wang
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China.
| | - Yuanhao Wu
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China
| | - Ping Huang
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China
| | - Weijia Chen
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China
| | - Zhenfen Wang
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China
| | - Yuna Wang
- Department of Anorectal Surgery, Hainan Provincial People's Hospital, Haikou, 570311, Hainan, China
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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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Lekarczyk A, Sinha H, Dvir D, Goyert J, Airhart A, Reddy RM. Similar hospital profits with robotic-assisted paraesophageal hiatal hernia repair, despite higher or supply costs. Surg Endosc 2022; 37:3952-3955. [PMID: 35999312 DOI: 10.1007/s00464-022-09513-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Robotic-assisted laparoscopic surgery has emerged as an alternative to traditional laparoscopy and may offer some clinical benefits when performing complex hiatal hernia repairs. Many institutions may choose to not invest in robotic surgery because of perceived higher costs, and when they already have proficient laparoscopic surgeons. We hypothesized that the robotic approach would yield lower profits overall due to higher supply costs, while offering comparable outcomes to the traditional laparoscopic approach. METHODS Financial and outcomes data from a single quaternary academic center was retrospectively reviewed from a prospectively collected database from July 2020 to May 2021. Laparoscopic hiatal hernia repairs and robotic-assisted repairs were compared for metrics including length of stay, operative time, hospital and supply cost, payments, and profits. Metrics of these two groups were compared using t-test analyses with significance set to p < 0.05. RESULTS Seventy-three patients were included with 31 in the robotic group (42.5%) and 42 in the laparoscopic group (57.5%). There were no significant differences in length of stay (robotic mean 2.0 days, laparoscopic 2.55 days, p = 0.09) or operative time (257.6 min vs 256.7 min, p = 0.48) between the two approaches. The robotic approach was associated with higher supply costs ($2,655 vs $2,028, p < 0.001) and patient charges ($63,997 vs $56,276, p < 0.05). Despite higher costs associated with robotics, hospital profits were not different between the two groups ($7,462 vs $7,939, p = 0.42). CONCLUSION Despite higher supply costs and charges for robotic-assisted hiatal hernia repair, hospital profits were similar when comparing robotic and laparoscopic approaches. Short-term clinical outcomes were also similar. Programs should do their own analysis to understand their individual cost issues.
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Affiliation(s)
- Andrew Lekarczyk
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Hana Sinha
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Danielle Dvir
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Joshua Goyert
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Austin Airhart
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Rishindra M Reddy
- University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
- Section of Thoracic Surgery, Department of Surgery, University of Michigan-Comprehensive Robotic Surgery Program, Jose Jose Alvarez Research Professor in Thoracic Surgery, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes. J Am Coll Surg 2022; 235:149-156. [PMID: 35839388 DOI: 10.1097/xcs.0000000000000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration. STUDY DESIGN This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest. RESULTS A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001). CONCLUSIONS Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.
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Parini S, Massera F, Papalia E, Baietto G, Bora G, Rena O. Port Placement Strategies for Robotic Pulmonary Lobectomy: A Narrative Review. J Clin Med 2022; 11:jcm11092612. [PMID: 35566741 PMCID: PMC9103382 DOI: 10.3390/jcm11092612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Despite the use of robotics becoming increasingly popular among thoracic surgeons worldwide, there remains debate over the best robotic approach for lung resections. In this paper, we delineated the main port placement strategies and discussed their advantages and disadvantages. Methods: A PubMed literature review was performed using key phrases such as “robotic lobectomy technique”, “RATS lobectomy”, and “port placement robotic lobectomy”. After the final review, 22 articles were included as references, of which 10 described common robotic port mapping techniques. Results: Several port strategies for robot-assisted pulmonary lobectomies have been proposed and described in the literature, each showing its own limitations and advantages. Conclusions: New robotic surgeons may choose their port strategy according to personal preference and previous surgical experience, especially regarding open or VATS resections. Robust data comparing different port placements in robotic surgery are lacking. Further research should be directed toward comparisons of clinical outcomes with different robotic approaches.
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Affiliation(s)
- Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
- Correspondence:
| | - Fabio Massera
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Esther Papalia
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Guido Baietto
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Giulia Bora
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy; (F.M.); (E.P.); (G.B.); (G.B.); (O.R.)
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
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Shah A, Nance JW, Chihara R, Chan EY, Kim MP. Robot-Assisted Thoracoscopic Lobectomy of T4 Lung Cancer. Ann Thorac Surg 2022; 114:e265-e267. [PMID: 35026147 DOI: 10.1016/j.athoracsur.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
A 79-year-old male former smoker presented with a T4 (>7cm) adenocarcinoma of the right upper lobe (RUL). The patient was staged at clinical T4N0M0 and underwent robot-assisted right upper lobectomy and mediastinal lymph node dissection. The patient was discharged home on postoperative day 3. Larger tumors are a relative contraindication for VATS lobectomy. The robot platform overcomes the technical limitations of VATS and allows for the successful resection of large tumors.
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Affiliation(s)
- Anuj Shah
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - John W Nance
- Department of Radiology, Houston Methodist Hospital, Houston, TX
| | - Ray Chihara
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX
| | - Edward Y Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX
| | - Min P Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX.
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Ma J, Li X, Zhao S, Wang J, Zhang W, Sun G. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis. BMC Cancer 2021; 21:498. [PMID: 33941112 PMCID: PMC8094485 DOI: 10.1186/s12885-021-08241-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background It remains no clear conclusion about which is better between robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for the treatment of patients with non-small cell lung cancer (NSCLC). Therefore, this meta-analysis aimed to compare the short-term and long-term efficacy between RATS and VATS for NSCLC. Methods Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases were comprehensively searched for studies published before December 2020. The quality of the articles was evaluated using the Newcastle-Ottawa Scale (NOS) and the data analyzed using the Review Manager 5.3 software. Fixed or random effect models were applied according to heterogeneity. Subgroup analysis and sensitivity analysis were conducted. Results A total of 18 studies including 11,247 patients were included in the meta-analyses, of which 5114 patients were in the RATS group and 6133 in the VATS group. Compared with VATS, RATS was associated with less blood loss (WMD = − 50.40, 95% CI -90.32 ~ − 10.48, P = 0.010), lower conversion rate (OR = 0.50, 95% CI 0.43 ~ 0.60, P < 0.001), more harvested lymph nodes (WMD = 1.72, 95% CI 0.63 ~ 2.81, P = 0.002) and stations (WMD = 0.51, 95% CI 0.15 ~ 0.86, P = 0.005), shorter duration of postoperative chest tube drainage (WMD = − 0.61, 95% CI -0.78 ~ − 0.44, P < 0.001) and hospital stay (WMD = − 1.12, 95% CI -1.58 ~ − 0.66, P < 0.001), lower overall complication rate (OR = 0.90, 95% CI 0.83 ~ 0.99, P = 0.020), lower recurrence rate (OR = 0.51, 95% CI 0.36 ~ 0.72, P < 0.001), and higher cost (WMD = 3909.87 USD, 95% CI 3706.90 ~ 4112.84, P < 0.001). There was no significant difference between RATS and VATS in operative time, mortality, overall survival (OS), and disease-free survival (DFS). Sensitivity analysis showed that no significant differences were found between the two techniques in conversion rate, number of harvested lymph nodes and stations, and overall complication. Conclusions The results revealed that RATS is a feasible and safe technique compared with VATS in terms of short-term and long-term outcomes. Moreover, more randomized controlled trials comparing the two techniques with rigorous study designs are still essential to evaluate the value of robotic surgery for NSCLC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08241-5.
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Affiliation(s)
- Jianglei Ma
- Student of the College of Basic Medical Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
| | - Xiaoyao Li
- Student of the College of Basic Medical Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
| | - Shifu Zhao
- Student of the College of Basic Medical Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
| | - Jiawei Wang
- Student of the College of Basic Medical Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
| | - Wujia Zhang
- Student of the College of Basic Medical Sciences, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China
| | - Guangyuan Sun
- Department of Thoracic Surgery, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
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