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. MethodsThe 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). ResultsA 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. ConclusionRobot-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.
ObjectiveTo summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor.MethodsA retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed.ResultsAll the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489(26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000).ConclusionCompared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.
ObjectiveTo summarize the clinical effect of Da Vinci robot radical gastrectomy for gastric cancer.MethodsA retrospective analysis was performed on 200 patients undergoing radical surgery for Da Vinci robotic gastric cancer from the General Surgery of the 940th Hospital of the Chinese People's Liberation Army from December 2016 to January 2018.ResultsThere were 200 cases of robotic radical gastric cancer, 99 cases of radical distal gastrectomy, and 101 cases of radical total gastrectomy. The operative time was (241.0±33.3) min, intraoperative blood loss was (146.2±110.4) mL, and the number of lymph nodes cleaned was (42±14). The time of first anal exhaustion was (3.1±0.7) d, the time of first meal was (4.3±0.7) d, the postoperative extubation time was (5.3±0.5) d, and the postoperative hospitalization cost was (96 366.50±16 992.87) yuan. Tumor diameter was (4.5±2.0) cm. The degree of tumor differentiation was high differentiation in 7 cases, moderate differentiation in 61 cases and poor differentiation in 132 cases. TNM stage was 1 case in stage Ⅰ, 62 cases in stage Ⅱ and 137 cases in stage Ⅲ. Iauren was divided into intestinal type (78 cases), diffuse type (65 cases) and mixed type (57 cases). The tumor infiltrated into submucosa in 1 case, intrinsic muscularis in 3 cases, subserosal layer in 31 cases and serosal layer in 165 cases. The tumors were located in the upper part of the stomach in 45 cases, the lower part of the stomach in 106 cases, the body of the stomach in 46 cases, the whole stomach in 1 case, and the gastroesophageal junction in 2 cases. Postoperative complications occurred in 8 cases (4%), including anastomotic leakage in 4 cases, duodenal stump fistula in 1 case, tracheoesophageal fistula in 1 case, pulmonary infection in 1 case, and gastroparesis in 1 case.ConclusionThe DaVinci robotic surgical system has less surgical injuries, quicker postoperative recovery, and better clinical efficacy.
ObjectiveTo estimate postoperative pain and use of analgesic of patients who underwent video-assisted thoracoscopic surgery(VATS) or robotic assisted thoracoscopic surgery(RATS). MethodsFrom October 2014 through August 2015, 339 patients were treated by surgery in Shanghai Chest Hospital. Among them, 116 patients with intrathoracic lesions who underwent RATS with the da Vinci? Surgical System were as a RATS group with 51 males and 65 females at age of 52.59±11.49 years. Another 223 patients by VATS were as a VATS group with 93 males and 130 females at age of 58.00±10.56 years. We recorded the data of the VAS score and use analgesic of the patients after surgery. ResultsThere was a significant difference in VAS score between the RATS group and the VATS group(3.01±0.18 vs. 5.19±0.14, P<0.05). Astatistical difference of analgesic use between RATS and VATS was also found(1.09±0.12 vs. 1.77±0.10, P<0.05). ConclusionCompared with VATS, the postoperative pain of the patients who underwent RATS is lighter. And the use of analgesic is less.
ObjectiveTo explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. MethodThe data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. ResultsA total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. ConclusionsFrom the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.
ObjectiveTo investigate the role of laparoscopic pancreaticoduodenectomy (LPD) for periampullary carcinoma. MethodsThis is a retrospective review of all periampullary carcinomas consecutively performed between January 2013 and January 2016 in Zhejiang Provincial People's Hospital. ResultsFifty-one patients underwent LPD. Conversion to open procedure was required in three cases. The operative time was (370±104) min, The estimated blood loss was (220.7±180.9) mL. Five cases had binding pancreaticogastric anastomosis, the other patients underwent duct to mucosa pancreaticojejunal anastomosis. Post operatively hospital stay was (14.6±11.2) days. The represented morbidity including pancreatic fistula (9 cases), postoperative intraperitoneal bleeding (2 cases), postoperative gastrointestinal bleeding (2 cases), delayed gastric emptying (4 cases), and bile leakage (4 cases). All patients underwent R0 resection. Postoperative pathological results: pancreatic adenocarcinoma: 28 cases, duodenal papillary adenocarcinoma: 12 cases, common bile duct adenocarcinoma: 11 cases. Conciusions LPD has been proven to be a safe procedure. Our LPD approach can improve the effectiveness of lymphadenectomy. It combined with resection of portal vein can improve the R0 resection rate of periampullary adenocarcinoma and is associated with better survival of those patients.
ObjectiveTo compare the differences in the learning curve and surgeon's perception for pulmonary lobectomy performed by a single surgeon using the da Vinci surgical robot versus a domestically-made robotic system. Methods A retrospective analysis was conducted on the clinical data of the first 70 consecutive patients who underwent lobectomy with the da Vinci robot and the first 70 with a domestic robot. All procedures were performed by a single thoracic surgeon at Gansu Provincial Hospital who initiated the use of both systems concurrently between 2021 and 2024. Data were analyzed using SPSS 26.0, and learning curves for both groups were plotted and analyzed using the cumulative sum (CUSUM) method. Results The da Vinci group included 41 males and 29 females with a mean age of (66.0±6.83) years and the domestic robot group included 42 males and 28 females;with a mean age of (65.09±6.14) years. For the da Vinci group, the mean operative time was (196.14±29.63) min. The CUSUM learning curve was best fitted by a cubic equation (R2=0.986; CUSUM=0.012X3−1.799X2+69.149X−59.239, where X was the surgical volume), which peaked at the 26th case, delineating the learning and mastery phases. Statistically significant differences were observed between these phases in operation time, setup time, console time, intraoperative blood loss, postoperative day 1 drainage, and number of lymph nodes dissected (all P<0.01). For the domestic robot group, the mean operative time was (187.57±24.62) min. Its CUSUM learning curve also followed a cubic fit (R2=0.910; CUSUM=0.008X3−1.152X2+40.465X+91.940), peaking at the 18th case. Significant improvements between the learning and mastery phases were also found for the same surgical metrics (all P<0.05). The surgeon's perception score was significantly higher for the da Vinci system compared to the domestic system (4.21±0.88 vs. 3.29±1.02, P<0.05). ConclusionCUSUM analysis effectively distinguishes the learning and mastery phases for both systems. The learning curve for da Vinci robotic lobectomy is overcome after 26 cases, whereas the domestic robot required 18 cases. In the mastery phase, operative time, setup time, intraoperative blood loss, and postoperative day 1 drainage are significantly lower, while the number of lymph nodes dissected is significantly higher compared to the learning phase for both systems. There are no significant differences in short-term efficacy or safety between the two groups. However, the da Vinci system provids a superior surgeon experience.
ObjectiveTo summarize the perioperative outcome of patients undergoing robot-assisted thoracic surgery (RATS) or four-port single-direction video-assisted thoracic surgery (VATS) right upper lobectomy (RUL), and to discuss the safety and the essentials of the surgery.MethodsThe clinical data of 579 patients with non-small cell lung cancer (NSCLC) undergoing minimally invasive RUL in Dr. Luo Qingquan’s team of our center from 2015 to 2018 were retrospectively analyzed. There were 246 males and 333 females aged 33-78 years. The 579 patients were divided into a RATS group (n=283) and a VATS group (n=296) according to surgical methods. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, postoperative complications and surgery cost were compared between the two groups.ResultsThere was no significant difference in baseline data between the two groups (P>0.05), and no postoperative 30 d mortality or intraoperative blood transfusion was observed. Compared with VATS, RATS had shorter operation time (90.22±12.16 min vs. 92.68±12.26 min, P=0.016), postoperative hospital stay (4.67±1.43 d vs. 5.31±1.59 d, P<0.001) and time of drainage (3.55±1.38 d vs. 4.16±1.58 d, P<0.001). No significant difference was observed between the two groups in the lymph nodes dissection, blood loss volume, conversion rate or complications. The cost of RATS was much higher than that of VATS (93 275.46±13 276.69 yuan vs. 67 082.58±12 978.17 yuan, P<0.001).ConclusionThe safety and effectiveness of robot-assisted and video-assisted RUL are satisfactory, and they have similar perioperative outcomes. However, RATS costs relatively shorter operation time and postoperative hospital stay.
ObjectiveTo systematically review the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for patients with non-small cell lung cancer (NSCLC). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 9, 2016), Web of Science, CNKI, VIP, WanFang Data and CBM databases to collect clinical studies about RATS vs. VATS for patients with NSCLC from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 cohort studies involving 19 921 patients were included; among them, 4 322 cases were in the RATS group, and 15 599 were in the VATS group. The results of meta-analysis showed that the operation time (MD=22.90, 95%CI 9.97 to 35.84, P<0.000 5) was longer in the RATS group than the VATS group. However, the conversion rate (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), the incidence of postoperative complications (OR=1.06, 95%CI 0.96 to 1.17, P=0.28), intraoperative blood loss (MD=2.75, 95%CI –8.39 to 13.89, P=0.63), postoperative hospitalization time (MD=–0.00, 95%CI –0.02 to 0.02, P=0.99) and in-hospital mortality rate (OR=0.60, 95%CI 0.35 to 1.05, P=0.07) were not significant differences between both groups.ConclusionThe current meta-analysis indicates that the efficacy and safety of RATS and VATS for NSCLC is equivalence, however the operation time for RATS is longer. Due to the limited quantity and quality of inclued studies, the above conclusions still need to be verified by more high quality studies.
ObjectiveTo analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.MethodsA total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.ResultsOverall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.ConclusionThere is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.