ABSTRACT
@#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.
ABSTRACT
Venous air embolism can occur in the various situations during operation. We experienced a case of cardiac arrest due to iatrogenic venous air embolism. A 62 year old man was underwent thoracotomy for lung cancer with one lung ventilation in the left lateral decubitus position. Finished right upper lobectomy, surgeon insufflated air into intraabdominal cavity through diaphragm to reduce dead spacce of thoracic cavity. After insufflating air, blood pressure and heart rate dropped suddenly and then cardiac arrest was developed immediately. We performed cardiac resuscitation with mannual cardiac compression, various cardiotonic drugs and removal of air through opened right atrium, and resulted in good hemodynamic recovery. At the time of discharge, the patient has recovered almost completely with mild short term memory loss and hoarseness.