ABSTRACT
OBJECTIVE: In recent years, there has been an increasing focus on minimally invasive mediastinal surgery using a trans-subxiphoid single-port thoracoscopic approach. Despite its potential advantages, the widespread adoption of this method has been hindered by the intricate surgical maneuvers required within the confined retrosternal space. Robotic surgery offers the potential to overcome the limitations inherent in the thoracoscopic technique. METHODS: This was a clinical trial (NCT05455840) to evaluate the feasibility and safety of utilizing the da Vinci® SP system (Intuitive Surgical, Sunnyvale, CA, USA) for trans-subxiphoid single-port surgery in patients with anterior mediastinal disease. The primary endpoints encompassed conversion rates and the secondary endpoints included the occurrence of perioperative complications. RESULTS: Between August 2022 and April 2023, a total of 15 patients (7 men and 8 women; median age = 56 years, interquartile range [IQR]: 49 to 65 years) underwent trans-subxiphoid robotic surgery using da Vinci SP platform for maximal thymectomy (n = 2) or removal of anterior mediastinal masses (n = 13). All surgical procedures were carried out with success, with no need for conversion to open surgery or the creation of additional ports. The median docking time was 2 min (IQR: 1 to 4 min), while the console time had a median of 152 min (IQR: 95 to 191 min). There were no postoperative complications and patients experienced a median postoperative hospital stay of 2 days with no unplanned 30-day readmission. CONCLUSIONS: This study shows that trans-subxiphoid single-port robotic surgery employing the da Vinci SP system in patients with anterior mediastinal disease is clinically viable with acceptable safety and short-term outcomes.
ABSTRACT
BACKGROUND & AIMS: There is minimal data regarding the long-term effects of targeted daily protein intake and its role in nutritional restoration. This study aims to evaluate the effect of protein supplementation among upper gastrointestinal (GI) surgical patients, reviewing the effect on muscle mass and hand grip strength. METHODS: The records of 223 upper GI surgical patients from September 2017 to June 2021 were retrospectively reviewed. Protein intake was categorised based on average daily protein intake (0.8g-1.2 g/kg/day vs. more than 1.2 g/kg/day), depending on compliance to the institution target of 1.2g-1.5 g/kg/day. Hand grip strength and body composition including weight, Body Mass Index (BMI), Fat-Free Mass (FFM), and Fat Mass (FM) were measured. Paired t-tests and independent t-tests were used to analyse the effects of different levels of protein intake on hand grip strength and body composition. RESULTS: Among the 223 patients included, 84 subjects had benign upper GI pathology and 139 subjects had malignant upper GI pathology, with mean follow-up duration of 52.3 (SD,42.10) weeks and 39.3 (SD,35.11) respectively. Patients with malignant pathology who consumed more than 1.2 g/kg/day of protein had increased hand-grip strength and preservation of FFM, while those who consumed 0.8g-1.2 g/kg/day of protein had deteriorating hand grip strength and significant FFM reduction (p = 0.004). Patients with benign pathology showed significant improvement in hand-grip strength (p < 0.001) and increase in FFM (p < 0.001) with higher protein intake. CONCLUSION: Protein supplementation is paramount in nutrition recovery and muscle mass restoration among upper gastrointestinal surgical patients. Protein intake of at least 1.2 g/kg/day was especially important among patients with malignancy to preserve muscle mass and strength.
