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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.
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@#Objective To explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery. Methods The clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery. Results Logistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery. Conclusion For elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.
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Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.
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Future medical technology breakthroughs will build from the incredible progress made in computers, biotechnology, and nanotechnology and from the information learned from the human genome. With such technology and information, computer-aided diagnoses, organ replacement, gene therapy, personalized drugs, and even age reversal will become possible. True 3-dimensional system technology will enable surgeons to envision key clinical features and will help them in planning complex surgery. Surgeons will enter surgical instructions in a virtual space from a remote medical center, order a medical robot to perform the operation, and review the operation in real time on a monitor. Surgeons will be better than artificial intelligence or automated robots when surgeons (or we) love patients and ask questions for a better future. The purpose of this paper is looking at the future medical science and the changes of colorectal surgeons.
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Humanos , Inteligência Artificial , Biotecnologia , Diagnóstico , Terapia Genética , Genoma Humano , Amor , Nanotecnologia , Cirurgiões , TelemedicinaRESUMO
[Summary] Endometrial carcinoma is one of the most common malignant tumors in female reproductive system .The treatment is given priority to with surgery .As a kind of minimally invasive surgery , the da Vinci robot surgical technique has become more and more mature in the past ten years and played an increasingly important role in gynecological oncology .As compared with the traditional laparoscopic surgery , the main advantages of the da Vinci robotic surgery system are as follows: improved three-dimensional surgical field, improved operation dexterity by mechanical wrist , and improved accuracy of operation by tremor filtering system .These innovations can help gynecological oncologists complete difficult surgery , especially for patients diagnosed of endometrial cancer with severe obesity.This article summarized the application of the da Vinci robotic surgery system in the treatment of endometrial carcinoma and compared it with the open surgery and traditional laparoscopic surgery .The new robot surgery system , innovation, applicable people and the learning curve were also involved .
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Surgical resection is the only potentially curative therapeutic method for patients with gastric cancer. However, con-ventional laparotomy is sometimes associated with considerable complications and mortality rate. This procedure also affects patient quality of life after surgery. Minimally invasive techniques can potentially provide an attractive alternative to current surgical proce-dures in terms of reducing surgical injury and accelerating postoperative recovery. Minimally invasive surgery for gastric cancer has re-cently been reasonably applied to two distinct forms of intervention:endoscopic resection of the tumor and laparoscopic surgery. In the near future, sentinel node navigation and robot surgery will provide more options for treating gastric cancer. Such developments will im-prove the quality of life of patients following surgery for gastric cancer. Various well-designed clinical trials of the minimally invasive techniques are available. Thus, the mode of surgery for gastric carcinoma will be widely accepted and rapidly developed worldwide.
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PURPOSE: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching. METHODS: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors. RESULTS: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593). CONCLUSION: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.
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Humanos , Tempo de Internação , Linfonodos , Métodos , Esvaziamento Cervical , Pescoço , Metástase Neoplásica , Duração da Cirurgia , Satisfação do Paciente , Pontuação de Propensão , Estudos Retrospectivos , Viés de Seleção , Tireoglobulina , Glândula Tireoide , Neoplasias da Glândula TireoideRESUMO
A 47-year-old man was referred to Seoul National University Bundang Hospital with an ulcerative lesion in the midbody of the stomach. Computed tomography revealed that he was a situs inversus totalis (SIT) patient. Robot-assisted distal gastrectomy with D1+beta lymph node dissection and Billroth II anastomosis were performed. With the aid of robotic surgery, the surgeon didn't need to change his position and could perform the surgery without any confusion resulting from the patient's reversed anatomy. The operation took 300 minutes, with no intraoperative complications. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The final pathologic report was pT3N3a by American Joint Committee on Cancer 7th tumor-node-metastasis staging. We successfully performed robot-assisted distal gastrectomy for gastric cancer in a SIT patient. We believe that this is the first case of robotic surgery reported in a SIT patient with gastric cancer.