Objective To investigate the learning curve for da Vinci robot-assisted mediastinal tumor resection (DRMTR). Methods A total of 50 consecutive patients received DRMTR between March 2011 and September 2012 in our hospital. Clinical data of the 50 patients were collected and analyzed. There were 23 males, 27 females aged 46.9(17–80) years. The learning curve was evaluated by using the cumulative sum (CUSUM) analysis. Results The mean operation time was 124.6 min. The CUSUM learning curve was best modeled as a third-order polynomial curve with the equation: CUSUM=0.046×case-number3–4.681×case-number2+127.508×case-number–237.940, which had a highR2 value of 0.868. The fitting curve reached the top after the 19th case, which suggested that the surgeons master the technique after they finished 19 cases. As a cut-off point, the 19th case divided the learning curve into two phases, in which there was statistical diffference in operation time (P<0.01), intraoperative blood loss (P<0.01), the postoperative duration of chest tube drainage (P<0.01 ) and the rate of postoperative complications (P<0.05 ). Conclusion The DRMTR identified by CUSUM analysis represents two characteristic stages of DRMTR: the learning stage and the mastery stage. It is suggested from our data that the surgeons need finish about 19 cases to master DRMTR.
目的 总结达芬奇机器人手术系统在胸外科的应用体验。 方法 回顾性分析 2016 年 1～11 月我院胸外科行肺叶切除和纵隔肿瘤切除 33 例患者的临床资料，其中男 24 例、女 9 例，年龄 51.3（22～76）岁。肺叶切除 18 例，肺楔形切除+肺段切除 11 例，纵隔肿瘤切除 4 例。分别对患者手术时间、淋巴结清扫数、中转开胸数、严重并发症（包括特发性急性肺损伤、呼吸衰竭、支气管胸膜瘘）、术中死亡人数等指标进行数据处理分析。 结果 33 例患者肺叶切除 18 例，术后病理证实为恶性肿瘤 9 例，肺结核 5 例，支气管扩张症 4 例；肺楔形切除+肺段切除 11 例，术后病理证实为结核球 8 例，良性结节 3 例。肺部疾病手术时间 90～210（130.7±50.6）min，淋巴结清扫 6～28（18.0±12.2）枚，纵隔肿瘤手术时间 60～90（78.3±32.9）min。所有患者均顺利完成手术，无严重并发症（特发性急性肺损伤、呼吸衰竭、支气管胸膜瘘），无中转开胸。 结论 达芬奇 Si 系统使微创技术有了新的生命力，为微创手术技术的进一步发展提供了可能。
Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.
Objective To investigate the clinical effect of digital drainage system (DDS) in patients after robot-assisted lobectomy. MethodsThe clinical data of the patients who underwent da Vinci robot-assisted lobectomy from August 2020 to December 2021 were retrospectively analyzed. The patients were divided into a DDS group and a conventional group (using traditional single thoracic drainage tube device) according to different drainage devices used after operation. The preoperative data, intraoperative blood loss, total drainage volume within 48 h after operation, postoperative extubation time and postoperative hospital stay were compared between the two groups. ResultsFinally, 170 patients were collected, including 76 males and 94 females with an average age of 61.8±8.7 years. Postoperative extubation time [5.53 (6.00, 7.00) days vs. 6.36 (6.00, 8.00) days, Z=–2.467, P=0.014] and postoperative hospital stay [7.80 (8.00, 10.00) days vs. 8.94 (9.00, 10.00) days, Z=–2.364, P=0.018] in the DDS group were shorter than those in the conventional group. For patients with postoperative persistent air leak, postoperative extubation time (Z=–2.786, P=0.005) and postoperative hospital stay (Z=–2.862, P=0.003) in the DDS group were also shorter than those in the conventional group. ConclusionDDS has a positive effect on enhanced recovery after robot-assisted lobectomy, which is safe and stable, and is beneficial to postoperative rehabilitation and shortening the average hospital stay.
Objective To summarize our initial experience in robot-assisted lobectomy for the treatment of non-small cell lung cancer （NSCLC）. Methods A total of 20 NSCLC patients underwent robot-assisted pulmonary lobectomy in General Hospital of Shenyang Military Command from March to September 2012. There were 13 males and 7 females, and their age was 43-80 （60.40±8.07） years. Single-direction thoracoscopic lobectomy technique was used，and systemic mediastinal and hilar lymph node dissection was routinely performed during the operation. There were 4 right upper lobectomies，7 right lower lobectomies，1 right middle lobectomy，7 left lower lobectomies，and 1 left upper lobectomy. Results Postoperative pathological examination showed adenocarcinoma in 12 patients，squamous cell carcinoma in 5 patients，adenosquamous carcinoma in 2 patients，and mucoepidermoid carcinoma in 1 patient. One patient undergoing left upper lobectomy had intraoperative pulmonary artery bleeding of 500 ml，who was healed by pulmonary artery repair via an accessory small incision and blood transfusion of 400 ml. All the other 19 patients successfully underwent robot-assisted lobectomy with their mean intraoperative blood loss of 60.00±42.95 （10-200） ml, and no blood transfusion was needed for them. All the patients were successfully extubated after operation, and none of the patients had severe postoperative complication. The mean thoracic drainage time was 9.35±3.48 （3-15） days. All the patients were discharged uneventfully and followed up for 2-9 （6.01±2.09） months without recurrence or metastasis. Conclusions Robot-assisted pulmonary lobectomy using Da Vinci S Surgical System is safe and feasible，and especially advantageous for lymph node dissection. It can be used for the treatment of early stage NSCLC.
Objective To investigate application values and techniques of robot-assisted extended thymectomy for the treatment of typeⅠmyasthenia gravis （MG） using Da Vinci S system. Methods We retrospectively analyzed clinical data of 3 patients with MG who underwent robot-assisted extended thymectomy in General Hospital of Shenyang Military Command from March 2012 to September 2012. All the patients were ocular MG （typeⅠ） including 2 men （33 years and 66 years old respectively） and 1 woman （21 years old）. Surgical outcomes were analyzed. Results All the 3 patients successfully received robot-assisted extended thymectomy without accessorial incisions. None of the patients required converting to open sternotomy or postoperative reexploration for bleeding. Intraoperative blood loss was 5-10 ml．Overall operation time was95-138 minutes, and thymoma dissection time was 26-80 minutes. No myasthenic crisis or other major postoperative complic-ation occurred. Postoperative chest drainage duration was 3-9 days and postoperative hospital stay was 10-15 days. Two patientswere followed up for 6-12 months after discharge without MG recurrence. Conclusion Robot-assisted extended thymectomy is safe and feasible for the treatment of typeⅠMG with satisfactory results．
ObjectiveTo evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with pulmonary lobectomy. MethodsWe retrospectively analyzed the clinical data of 50 patients in General Hospital of Shenyang Military Region of Thoracic Surgery between May 2012 and March 2015.The patients were divided into two groups. Twenty five patients aged over 70 years underwent radical operation of lung cancer with da Vinci Robot System were allocated into a robot group with 17 males and 8 females at age of 72.6 ±2.5 years. Another 25 senile patients with radical surgery by video-assisted thoracoscopic surgery (VATS) were allocated into a thoracoscopic group with 17 males and 8 females at age of 72.5±2.4 years. The patients in the two groups underwent pulmonary lobectomy and mediastinal lymph node dissection. The clinical effect of the two groups was compared. ResultsAll patients were diagnosed as lung cancer. Twenty five patients all completed surgery under da Vinci Robot System in the robot group. In the thoracoscopic group, one patient was converted to thoracotomy. There were statistical differences in amount of blood loss (66.2±44.2 ml vs. 356.0±349.2 ml, P=0.000), lymph node number (23.2±9.8 vs. 11.3±5.6, P=0.012), and postoperative bed time (3.5±0.9 d vs. 4.2±1.1 d, P=0.017) between the two groups. Effect in the robot group was superior to that in the thoracoscopic group. ConclusionDa Vinci robotic surgery system for elderly patients with lung cancer radical surgery is safe, effective, and less thoracoscopic surgery trauma, recovery faster.
ObjectiveTo investigate the effect of pressure control ventilation-volume guaranteed (PCV-VG) for patients undergoing da Vinci robotic-assisted pulmonary lobotomy. MethodA total of 40 patients undergoing Da Vinci robotic-assisted pulmonary lobotomy were randomly divided into two groups:a PCV-VG group (G group) and a volume-controlled ventilation (VCV) group (V group). There were 20 patients in each group with 13 males and 7 females at age of 49.0±5.5 years in the G group, 16 males and 4 females at age of 51.0±3.9 years in the V group. Haemodynamics indexes and oxygenation parameters were recorded at different times and compared between the two groups. ResultsDuring one-lung ventilation (OLV) period, the peak inspiratory pressure (Ppeak), respiratory index (RI) and arterial partial pressure of carbon dioxide (PaCO2) in the G group were statistically lower than those in the V group (P<0.05). While the Cdyn and inspired oxygen fraction(OI) were higher in the G group than those in the V group (P<0.05). ConclusionCompared with the traditional VCV ventilation mode, the PCV-VG ventilation mode improves Ppeak, Cdyn, OI, and RI of the patients undergoing da Vinci robotic-assisted pulmonary lobotomy.