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@#Objective To explore the feasibility of 5G remote robot-assisted pulmonary lobectomy through animal experiments. Methods In this research, the Toumai® surgical robot was manipulated remotely by the surgeon in the Control Center of the MedBot Company through the 5G network established by China Telecom, and the experimental pig underwent lobectomy in simulated operating room. Results The animal experiment surgery was successfully completed. The surgeon remotely manipulated the surgical robot to complete the lobectomy of right apical lobe and mediastinal lymph node dissection. The entire animal experiment took about 60 minutes, with an average round-trip network delay of 125 (110-155) ms, and no network interruption or robot malfunction occurred. Conclusion This animal experiment is the first attempt of 5G remote thoracic surgery, which preliminarily proves the feasibility of completing remote lobectomy through the Toumai® surgical robot 5G wireless network connection. The systematic surgical procedure is summarized, which lays a foundation for the subsequent experiments and clinical applications of 5G remote robot-assisted thoracic surgery.
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@#Lung cancer is one of the most prevalent and deadly malignances worldwide. Cigarette smoking has been identified to be the major risk factor of lung cancer, and nicotine is one of the most harmful components in tobacco smoke. Nicotinic acetylcholine receptors (nAChRs) are universally expressed in mammalian cells, including tumor cells, and perform various critical biological functions. α7nAChR, an important member of nAChRs family, possesses a high affinity for nicotine and plays a core role in the nicotine-mediated lung cancer cell proliferation, angiogenesis, invasion and metastasis. Nowadays, lots of α7nAChR antagonists have been found to inhibit lung cancer cell proliferation, invasion and angiogenesis in vitro and in vivo, and therefore prevented disease progression. These studies indicated that α7nAChR might be a potential target in treating lung cancer. In this review, we summarized the current researches on α7nAChR in the progress of lung cancer.
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@#Objective To analyze the efficacy and safety of Toumai® endoscopic surgery robot in right upper lobe resection. Methods The clinical data of 2 patients with non-small cell lung cancer who received right upper lobe resection with Toumai® endoscopic surgery robot in Shanghai Chest Hospital, Shanghai Jiao Tong University in November 2021 were retrospectively analyzed. Both patients were male, aged 66 years and 44 years, respectively. Results The operation was successful in both patients with no conversion to thoracotomy, surgical complication or death. The operation time was 65 min and 48 min, and the amount of intraoperative bleeding was 80 mL and 50 mL, respectively. The postoperative hospital stay was 3 days. There was no blood transfusion during the perioperative period. Conclusion The application of Toumai® endoscopic surgery robot in lobectomy is preliminarily proved to be safe and effective. Compared with Da Vinci robotic surgery system, it has similar clear 3D vision and flexible and stable operation, which can become one of the important choices for the new generation of minimally invasive chest surgery.
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@#Objective To investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. Methods We retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. Results A total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P<0.001). Conclusion In contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.
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Minimally invasive surgery, including laparoscopic and thoracoscopic procedures, benefits patients in terms of improved postoperative outcomes and short recovery time. The challenges in hand-eye coordination and manipulation dexterity during the aforementioned procedures have inspired an enormous wave of developments on surgical robotic systems to assist keyhole and endoscopic procedures in the past decades. This paper presents a systematic review of the state-of-the-art systems, picturing a detailed landscape of the system configurations, actuation schemes, and control approaches of the existing surgical robotic systems for keyhole and endoscopic procedures. The development challenges and future perspectives are discussed in depth to point out the need for new enabling technologies and inspire future researches.
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Objective:To investigate the efficacy of Da Vinci robot-assisted surgery for mediastinal tumor, and summarize the value of Da Vinci system in mediastinal surgery.Methods:The clinical data of 339 cases of robot-assisted mediastinal mass in Shanghai Chest Hospital from April 2015 to September 2020 were retrospectively analyzed, to compare perioperative outcomes of robotic surgery and conventional video-assisted thoracoscopic surgery 2 949 cases.Results:All the operations were successfully completed as planned. No residual lesions, conversion or second operation was observed in the consecutive cohort. The operating time[(81.8±36.8)min vs.(95.6±58.3)min, P=0.015]and post-operation stay[(3.1±1.9)days vs.(3.8±2.3)days, P=0.002] were statistically shorter in robotic group than those inconventional thoracoscopic group. Intraoperative blood loss in two groups was similar[(43.2±22.6)ml vs.(44.0±33.4)ml, P>0.05]. Conclusion:The Da Vinci robot system in mediastinal surgery is safe and feasible with great perspective in the new age of minimally invasive thoracic surgery. Compared with thoracoscopic surgery, it can shorten the operation time and reduce the postoperative hospital stay. It has certain advantages in operator experience and patient recovery.
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@#Objective To 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. Methods The 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. Results There 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). Conclusion The 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.
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@# Robotic surgery system has been widely used in various types of pulmonary resections. With the unremitting efforts of Chinese thoracic surgeons, the quantity and quality of robotic pulmonary resections in China have reached a remarkable level. With the development and rapid promotion of this technology, the popularity of robotic surgery is also increasing. In order to standardize the clinical practice, guarantee the quality of treatment and promote the development of robotic pulmonary resections, the Committee of Thoracic Surgery, Doctor Society of Medical Robotics, Chinese Medical Doctor Association organized relevant domestic experts to formulate the consensus of Chinese clinical experts on robot-assisted lung cancer surgery.
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Minimal invasive surgery with short operation time and enhanced recovery after surgery can truly achieve biological minimal invasiveness. The minimal invasive lung cancer surgery includes several kinds, such as uni-portal video-assisted thoracoscopic surgery (VATS) and multi-portal VATS. Robotic-assisted thoracic surgery (RATS) can be categorized into multi-portal VATS. As a frontier technology of minimal invasive surgical technique, surgical robotic system has been broadly applied in many areas. The average RATS operation time is (91.51±30.80) min among our team, which is much shorter than reported uni-portal VATS operation time. For now, RATS has some drawbacks and is lacking of national practice guidelines, which, we believe, will be solved by technology development and large-scale randomized controlled trials. .
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Humans , Lung Neoplasms , General Surgery , Minimally Invasive Surgical Procedures , Methods , Robotics , Methods , Thoracic Surgery, Video-Assisted , MethodsABSTRACT
BACKGROUND@#Thoracoscopic lobectomy combined with mediastinal lymph node dissection has been considered as one of the standard surgical procedures for early lung cancer. After 20 years of development, thoracoscopic lobectomy has reached a consensus on reliability and minimally invasive. At present, thoracoscopic lobectomy has a variety of incisions, which gradually evolve into four holes based on three holes, and two or one hole as the operative approach. The aim of this study was to evaluate the clinical value of four-hole unilateral dissecting lobectomy and mediastinal lymph node dissection in the treatment of non-small cell lung cancer (NSCLC). The aim of this study was to investigate the clinical value of anatomical lobectomy with mediastinal lymphadenectomy under four-hole completely video-assisted thoracoscopic surgery (C-VATS) in the treatment of non-small cell lung cancer.@*METHODS@#The patients undergoing lobectomy with mediastinal lymphadenectomy for NSCLC were identified in the Department of Thoracic Surgery, Yangzhou First People's Hospital, Yangzhou University from March 2015 to July 2016. Preoperative clinical diagnosis of peripheral-type early NSCLC. The patients were randomly divided into four-hole monophasic group (experimental group) and three-hole group (control group) according to the number of hospitalization before surgery. According to inclusion and exclusion criteria, the 39 cases assign in experimental group and 34 cases in the control group, including 36 males and 37 females; aged 38 to 84 years. The mean operation time, average blood loss, lymph node dissection group, average drainage, average extubation time and postoperative complications were compared between the two groups for statistical analysis.@*RESULTS@#The two groups of patients were successfully completed surgery, no death after surgery. Mean bleeding in the two groups, the number of lymph node dissection group, the average postoperative drainage, the average time of extubation, postoperative complications, with no significant difference. The average operation time of the four-hole unidirectional group was shorter than that of the three-hole group. The difference was statistically significant (P<0.05).@*CONCLUSIONS@#The safety and efficacy of a four-hole one-way operation under VATS are satisfactory. The operation is smooth during operation, which shortens the course of operation and deserves the clinical promotion. .
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , General Surgery , Lung Neoplasms , General Surgery , Lymph Node Excision , Methods , Mediastinum , Operative Time , Pneumonectomy , Methods , Retrospective Studies , Thoracic Surgery, Video-Assisted , Time FactorsABSTRACT
Objective To evaluate the reliability of video-assisted mini-thoracectomy(VAMT) for the diagnosis and treatment of patients with pulmonary peripheral nodules.Methods A total of 55 patients with pulmonary peripheral nodules(1 case of multiple nodules and 54 cases of solitary nodule) underwent VAMT.The surgery included wedge resection in 23 patients and lobectomy with lymph node dissection in 32 patients(The lobectomy was performed by using conventional combined with thoracoscopic instruments.A self-made lymph node clamp was applied for lymph node dissection).Results The operation was successfully accomplished under thoracoscopy in all the 55 patients.The operation time was 35~180 min(mean,109 min) and the intraoperative blood loss was 50~400 ml(mean,122 ml).No blood transfusion was required.Postoperative complications included air leakage in 1 patient(discharge on the 32 postoperative day) and delayed wound healing in 1 patient(discharge on the 19 postoperative day).The length of postoperative hospital stay of the other 53 patients was 4~11 days(mean,8.3 days).Final pathological diagnosis showed 15 cases of benign lesions,38 cases of primary lung carcinoma,1 case of atypical adenomatous hyperplasia,and 1 case of metastatic lung cancer.The benign lesions were cured by wedge resection.Anatomic lobectomy with lymph node dissection was performed in 32 patients with primary lung cancer.Of other 6 patients with terminal lung cancer,4 patients were conservatively treated because of an extensive dissemination and 2 patients received a palliative wedge resection because of poor pulmonary functions.Conclusions Video-assisted mini-thoracectomy is helpful for the diagnosis and treatment of pulmonary peripheral nodules.Its long-term effects for clinical early-stage lung cancer need further follow-up investigations.
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Background and purpose:VATS lobectomy has gained popularity for lung cancer around the world.Complete anatomic resections and node dissections are routinely being performed at many centers under VATS,but some thoracic surgeons are concerned regarding the safety,benefit and radical resection of this operative method.Our study is to evaluate the reliability and feasibility of pulmonary resection by video-assisted mini-thoractomy(VAMT) for patients with lung cancer.Methods:72 patients with lung cancer received either lobectomy and systemic lymph node dissection by video-assisted mini-thoracotomy(VAMT group;n=32) or conventional thoracotomy(conventional group;n=40),lobectomy was performed by conventional or thoracoscopic instruments,specific lymph node clamps were applied for lymph node dissection.Results:VAMT was successfully performed without significant postoperative complication and blood transfusion.No significant differences were observed in the two groups with respect to the length of operation and the total groups of dissected lymph nodes.This study showed that VAMT is a minimally invasive surgery without impairing of the outcome and needed less operative blood loss and shorter postoperative hospitalization compared to conventional thoracotomy.Conclusions:Major pulmonary resection by video-assisted minithoractomy for patients with lung cancer is safe,reliable and less invasive,it is consistant with the surgical standard of lung cancer.Its long-term benefit needs to be clarified after further follow-up.
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Purpose:To evaluate the clinical effects and indications of surgical treatment of non small lung cancer invading the left atrium and great vessels and trachea carina. Methods:From August 1998 to Auguest 2003, we performed operations on patients with non-small lung cancer invading the left atrium in 3 cases, invading the descending aorta in 1 case, invading trachea carina in 3 cases; all the patients have been examined to exclude distant metastasis, including nuclear bone scan to exclude bone metastasis; there were 2 cases of left pneumonectomy and one of right pneumonectomy invading the left atrium, there were 3 cases of right sleeve pneumonectomy invading the trachea carina. For the cases invading the descending aorta, we performed the operation with atrium-aorta bypass, Pathology examination: all of the cases were squamous lung cancer, staging of T 4N 0M 0 for 6 cases,T 4N 2M o for 1 case. Results:No complication, follow up: 6 cases survived more than 1 year,1 case survived more than 9 months;4 cases were alive for more than 3 years, 1 case invading the atrium died in 30 months because of brain metastasis,1 case invading the carina died in 15 months because of pulmonary infection. Conclusions:For localized advanced non-small lung cancer invading the aorta and invading the carina and the atrium, if we selected the patient correctly and with a good surgical technique with complete radical resection of the tumor ,we can acquire good results.
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Background and purpose:Single photonemisson computed tomography(PET) is recently available in many cities. It has been extensively used for the diagnosis of pulmonary lesions,especially in the differential diagnose of solitary pulmonary nodules(SPN) with PET.We retrospectively analysed 20 lung tumour patients with multifical lesions to investigate the value of PET scanning. Methods:20 cases with lung tumour patients who had multifical lesions were analyzed , the patients were treated from August 2004 to June 2005 in Shanghai Chest Hospital. All patients were examined with PET,X-ray,CT(computerized tomography) and SPECT(single photonemisson computed tomography). Some of them were detected with MRI because they were suspected to have spinal metastases. 14 cases were pathologically proved as lung cancer.Results:All(100%) of the primary lesions were positively detected by PET scanning. In addition to 100% sensitivity to the primary lesions, 6 cases of the metastatic lesions were confirmed by PET,in which 2 of them were pulmonary nodules (all bigger than 1cm in size),3 were mediastinal lymph nodes,and the other was a secondary tumor of the spine. 14 cases were negative on the PET image, 4 of 14 cases were false negative, 2 of them had pulmonary nodules (all smaller than 1cm), the other 2 were either mediastinal lymph nodes or a secondary tumors of the spine.Conclusions:PET scanning has high value in terms of improving diagnosis of the primary and metastatic pulmonary lesions, it is useful to define stage of tumor and chose proper treatment for the patients. PET scanning may not be a efficient tool when the size of nodules is smaller than 1 cm. Some of the secondary tumors of the spine maybe be PET negative.
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Purpose: To evaluate the causes and management of bronchial pleural fistula after pneumonectomy. Methods: Retrqspective analysis for Bronchus-pleural fistula( BPF) of 16 cases after pneumonectomy of 820 cases of lung cancer in our hospital. BPF occurred in right peumonectomy( 13/320) is more than in left pneumonectomy(3/500) . BPF occurred in the positive stump of bronchus ( 10/41) more than in negative stump of bronchus (6/779) ; BPF occurred in preoperative chemotherapy cases( 5/110) more than in non-preoperative chemotherapy cases( 11/710), No BPF occurred in the 70 cases in which the bronchial stump was covered by autogenous tissue. The management principle in early stage is thoracocentesis and wash with antibiotics; after identification of the infection in thoracic cavity or BPF, closed drainage for thorax was done. If the results of drainage are not very good, open drainage is necessary. Results: 2 cases were discharged with completely healing, (the cavity of 1 case was washed again and again with 5% NaHC03and urokinase , another case was operated again to cover the BPF using muscle flaps 3 days after the first operation), 8 cases were discharged with closed drainage, 4 cases were discharged with open drainage changing the wound covering every day, the BPF did not heal for a long time after open drainage in 1 case, 1 case died of function failure of body organs. Conclusions: BPF is related to management of the bronchial stump and radical resection for tumor, It is a useful method to cover the bronchial stump with autogenous tissues to decrease BPF's, especially for right pneumonectomy and preoperative chemotherapy or radiotherapy cases. The management principle of BPF is thoracocentesis for early cases, especially washing with antibiotics and 5% NaHC03and urokinase repeatedly, closed drainage when necessary is also a good method for curing empyema and BPF.