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@#Objective To evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with radical surgery of lung cancer. Methods We retrospectively analyzed the clinical data of 59 patients aged over 70 years who underwent radical surgery of lung cancer in our hospital between 2016 and 2019. These patients were divided into two groups including a da Vinci robot group and a single-utility port video-assisted thoracoscopic surgery (VATS) group according to the patients’ selection of the treatments. There were 32 patients with 20 males and 12 females aged 73.1±2.3 years in the da Vinci robot group and 27 patients with 16 males and 11 females aged 71.2±1.3 years in the VATS group. The clinical data of the two groups were compared. Results There was no statistical difference in surgery time between the two groups (t=–0.341, P=0.484). Compared with the VATS group, the da Vinci robot group had more number of lymph nodes dissected (t=1.635, P=0.015), less intraoperative blood loss (t=–2.569, P <0.001), less postoperative drainage amount within 3 days after surgery (t=–6.325, P=0.045), lower visual analogue scale (VAS) scores at postoperative 3rd day (t=–7.214, P=0.021). Conclusion The da Vinci robot system is safe and efficient in the treatment for elderly patients with radical surgery of lung cancer with less trauma.
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@#Objective Through the perioperative outcome analysis of da Vinci robot-assisted sleeve lobectomy, to clarify its efficacy and safety. Methods A retrospective analysis was performed on 10 patients with centrally located lung cancer undergoing robot-assisted sleeve lobectomy from March to December 2019 in our center, including 9 males and 1 female, aged 45-67 (55.0±8.9) years. Preoperative imaging and bronchoscopy showed central non-small cell lung cancer, involving the right upper lung in 3 patients, right lower lung in 2 patients, the left upper lung in 4 patients, and left lower lung in 1 patient. The operation time, Docking time, intraoperative blood loss volume, bronchial anastomosis time, number of dissected lymph nodes, drainage volume and postoperative hospital stay were analyzed. Results The da Vinci robot-assisted bronchial sleeve lobectomy was completed smoothly on 10 patients. The operation time was 135-183 (157.8±14.3) min, Docking time 6-15 (10.0±2.9) min, intraoperative blood loss volume 55-250 (124.5±61.8) mL, bronchial anastomosis time 17-40 (27.7±7.3) min, the number of dissected lymph nodes 16-23 (19.7±2.8), the drainage volume 200-600 (348.0±148.4) mL and postoperative hospital stay 7-11 (8.7±1.6) d. All patients had no bronchopleural fistula, pulmonary infection or atelectasis, and there was no perioperative death. Postoperative pathological findings were all squamous cell carcinoma. Conclusion Da Vinci robot-assisted sleeve lobectomy is safe and effective.
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@#Objective To 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. Methods A 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. Results All 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). Conclusion Compared 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.
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Background Surgical removal of parapharyngeal space tumors (PPST) poses challenges due to the complex anatomy of the region. PPSTs are routinely resected by a transcervical approach using blind finger dissection. Large PPSTs or those located high at the skull base, often require transmandibular or infratemporal fossa approaches, associated with considerable morbidity. Objective Here, we describe an approach for PPST removal that comprises transcervical endoscopic, with or without transoral robotic technique. Materials and Methods We retrospectively studied the demographic, clinical, surgical, and outcome data of 11 consecutive patients who underwent PPST excision between June 2013 and July 2017 at our center. Patients either underwent a transcervical endoscopic procedure ( n = 4), a transoral robotic procedure ( n = 2) or a combination of the two procedures ( n = 5). Results Complete tumor excision was achieved in all cases, with no intra-, peri-, or postoperative complications. Final histopathologic findings demonstrated pleomorphic adenoma for seven patients, cavernous hemangioma for one patient, and malignant tumors for three patients. The average tumor size was 44.22 ± 31.9 cm 3 (range: 7.5-111 cm 3 ). At follow-up (range: 3-42 months), there was no evidence of recurrence. Conclusions The approach described provides improved visualization and safe vascular control with minimum tumor stress, preventing the need for blind finger dissection, and allowing complete tumor removal while minimizing tumor spillage, nerve injury, and blood loss, maintaining excellent cosmetic and functional results. This approach could be utilized for the removal of large benign PPST, or small PPST located high.
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@#Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery (VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results There was no statistical difference in surgery time between the two groups (t=–0.365, P=0.681). Less intraoperative blood loss ( t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery ( t= – 6.325, P=0.045), shorter period of bearing drainage tubes after surgery ( t=–1.687, P=0.024), shorter hospital stays ( t= – 3.689, P=0.021), lower visual analogue scale (VAS) scores of postoperative 48 hours (t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.
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BACKGROUND: Parapharyngeal space tumors (PPSTs) pose exposure challenges; they are routinely resected by the transcervical approach using blunt/blind finger dissection, increasing the risk of tumor spillage and of neurovascular injury. Large PPSTs or those located high at the skull base often require mandibulotomy or an infratemporal fossa approach, baring considerable morbidity. METHODS: The novel minimally invasive approach described, utilizes endoscopic equipment introduced transcervically for circumferential separation of the tumor from the neurovascular structures of the skull base. After the tumor is separated, it is removed en bloc, via transoral robotic surgery (TORS). RESULTS: The technique provides improved visualization and safe vascular control with minimum tumor stress, preventing the need of blunt/blind finger dissections, and allowing complete tumor removal while minimizing tumor spillage, nerve injury, and blood loss, maintaining excellent cosmetic and functional results. CONCLUSION: This approach could be utilized for the removal of large benign PPSTs, or small PPSTs located high at the skull base. © 2017 Wiley Periodicals, Inc. Head Neck 39: 786-790, 2017.
