Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Shiyuan ^1,2 , WU Ziheng ^2,3 , XU Wei ² , WU Qiong ² , XU Shiguang ² , LIU Bo ² , DING Renquan ² , WANG Xilong ² , HU Yuhang ² ,  WANG Shumin ²

1. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Medical College of Zhejiang University, Hangzhou, 310009, P. R. China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Totally no tube; Da Vinci robot surgery system; mediastinal tumor; postoperative hospital stay; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202111028

Video：

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Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. Methods The clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). Results A total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. Conclusion Robot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.

Citation： SONG Shiyuan, WU Ziheng, XU Wei, WU Qiong, XU Shiguang, LIU Bo, DING Renquan, WANG Xilong, HU Yuhang, WANG Shumin. Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1396-1401. doi: 10.7507/1007-4848.202111028 Copy

1.	Kajiwara N, Taira M, Yoshida K, et al. Early experience using the Da Vinci surgical system for the treatment of mediastinal tumors. Gen Thorac Cardiovasc Surg, 2011, 59(10): 693-698.
2.	丁仁泉, 成名, 许世广, 等. 达芬奇机器人完全无管化与经剑突下胸腔镜手术治疗胸腺肿瘤围手术期效果的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(6): 818-823.
3.	刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
4.	Roden AC, Fang W, Shen Y, et al. Distribution of mediastinal lesions across multi-institutional, international, radiology databases. J Thorac Oncol, 2020, 15(4): 568-579.
5.	彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
6.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
7.	Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
8.	Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
9.	Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the Da Vinci surgical system for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
10.	方文涛, 谷志涛, 陈克能, 等. 胸腺肿瘤微创手术研究进展. 中国肺癌杂志, 2018, 21(4): 269-272.
11.	中国医师协会医学机器人医师分会胸外科专业委员会筹备组, 谭群友, 陶绍霖, 等. 机器人辅助纵隔肿瘤手术中国专家共识 (2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
12.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
13.	沈诚, 李珏, 李鹏飞, 等. 加速康复外科评价指标: 病人报告结局在胸外科的临床应用现状与进展. 中国肺癌杂志, 2019, 22(3): 161-166.
14.	唐善卫, 武强, 束余声. 肺癌术后胸腔闭式引流管理的现状与进展. 中华胸部外科电子志, 2019, 6(3): 182-186.
15.	叶雄, 陈刚, 唐继鸣, 等. 胸腔镜微创术后不留置胸腔引流管在快速康复外科中的应用. 中国胸心血管外科临床杂志, 2014, 21(1): 112-114.
16.	Ozdamar D, Turna C, Kibar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation: A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
17.	Pan WZ, Du J, Zhang LY, et al. The roles of NF-κB in the development of lung injury after one-lung ventilation. Eur Rev Med Pharmacol Sci, 2018, 22(21): 7414-7422.
18.	Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
19.	Mao S, Du X, Ma J, et al. A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing Nuss procedure. J Thorac Dis, 2018, 10(6): 3216-3224.
20.	Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
21.	丁磊, 马山, 王天佑, 等. 胸腔镜联合纵隔镜胸腺扩大切除治疗重症肌无力. 中华外科杂志, 2010, 6(11): 474-475.
22.	Padilla Alarcón J, Peñalver Cuesta JC. Experience with lung resection in a fast-track surgery program. Arch Bronconeumol, 2013, 49(3): 89-93.
23.	Zhao G, Huang Y, Chen X, et al. Research on fast track surgery application in lung cancer surgery. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 102-106.
24.	Wehberg KE, Jackson D, Walters J, et al. Fast track minimally invasive transmyocardial revascularization. Innovations (Phila), 2009, 4(4): 217-220.
25.	Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1): 58-63.
26.	Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.

1. Kajiwara N, Taira M, Yoshida K, et al. Early experience using the Da Vinci surgical system for the treatment of mediastinal tumors. Gen Thorac Cardiovasc Surg, 2011, 59(10): 693-698.
2. 丁仁泉, 成名, 许世广, 等. 达芬奇机器人完全无管化与经剑突下胸腔镜手术治疗胸腺肿瘤围手术期效果的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(6): 818-823.
3. 刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
4. Roden AC, Fang W, Shen Y, et al. Distribution of mediastinal lesions across multi-institutional, international, radiology databases. J Thorac Oncol, 2020, 15(4): 568-579.
5. 彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
6. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
7. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
8. Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
9. Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the Da Vinci surgical system for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
10. 方文涛, 谷志涛, 陈克能, 等. 胸腺肿瘤微创手术研究进展. 中国肺癌杂志, 2018, 21(4): 269-272.
11. 中国医师协会医学机器人医师分会胸外科专业委员会筹备组, 谭群友, 陶绍霖, 等. 机器人辅助纵隔肿瘤手术中国专家共识 (2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
12. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
13. 沈诚, 李珏, 李鹏飞, 等. 加速康复外科评价指标: 病人报告结局在胸外科的临床应用现状与进展. 中国肺癌杂志, 2019, 22(3): 161-166.
14. 唐善卫, 武强, 束余声. 肺癌术后胸腔闭式引流管理的现状与进展. 中华胸部外科电子志, 2019, 6(3): 182-186.
15. 叶雄, 陈刚, 唐继鸣, 等. 胸腔镜微创术后不留置胸腔引流管在快速康复外科中的应用. 中国胸心血管外科临床杂志, 2014, 21(1): 112-114.
16. Ozdamar D, Turna C, Kibar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation: A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
17. Pan WZ, Du J, Zhang LY, et al. The roles of NF-κB in the development of lung injury after one-lung ventilation. Eur Rev Med Pharmacol Sci, 2018, 22(21): 7414-7422.
18. Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
19. Mao S, Du X, Ma J, et al. A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing Nuss procedure. J Thorac Dis, 2018, 10(6): 3216-3224.
20. Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
21. 丁磊, 马山, 王天佑, 等. 胸腔镜联合纵隔镜胸腺扩大切除治疗重症肌无力. 中华外科杂志, 2010, 6(11): 474-475.
22. Padilla Alarcón J, Peñalver Cuesta JC. Experience with lung resection in a fast-track surgery program. Arch Bronconeumol, 2013, 49(3): 89-93.
23. Zhao G, Huang Y, Chen X, et al. Research on fast track surgery application in lung cancer surgery. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 102-106.
24. Wehberg KE, Jackson D, Walters J, et al. Fast track minimally invasive transmyocardial revascularization. Innovations (Phila), 2009, 4(4): 217-220.
25. Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1): 58-63.
26. Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization

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