本期胸小星将为大家带来改良剑突下VATS 胸腺切除术治疗胸腺恶性肿瘤的围手术期结局和生存率；单孔机器人系统在机器人胸腔镜手术中的应用，一起来看看吧！
2017·EATTS
01
Perioperative Outcomes and Survival of Modified Subxiphoid VATS Thymectomy for T2-3 Thymic Malignancies: A Retrospective Comparison Study
Xinyu Yang1, Jiahao Jiang1, Yongqiang Ao1, Yuansheng Zheng1, Jian Gao1, Hao Wang1, Fei Liang2, Qun Wang1, Lijie Tan1, Shuai Wang3, Jianyong Ding1
1 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
2 Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
3 Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.
Objective:
Our previous study demonstrated that modified subxiphoid VATS thymectomy (mSVT) with an auxiliary sternal retractor is feasible for locally invasive thymic malignancies. This study aimed to compare perioperative and oncological outcomes of mSVT versus median sternotomy thymectomy (MST) for locally advanced thymic malignancies.
Methods:
In total, 221 patients of T2-3 thymic malignancies who underwent mSVT or MST between 2015 and 2020 were enrolled in our prospectively maintained database. A 1:1 propensity score-matching analysis was performed to balance the bias. Surgical difficulty was evaluated by a modified resection index. Perioperative and oncological results were compared between mSVT and MST groups.
Results:
There were 72 patients in each group in the final analysis. Our results showed that the mSVT group had a shorter operative duration (98 vs. 129 min, P < 0.001), less blood loss (40 vs. 100 mL,P < 0.001), shorter drainage duration (3 vs. 5 days, P < 0.001), shorter length of hospital stay (5 vs. 6 days, P < 0.001) and fewer postoperative complications (5.6% vs. 23.6%; P = 0.005). No significant difference was detected in complete resection (98.6% vs. 98.6%, P = 1.000) between the two groups. Conversion occurred in 5/106 (4.7%). Survival analyses indicated similar recurrence-free survival (HR=0.94; 95% CI: 0.40-2.20; P = 0.883) and overall survival (HR=0.52; 95% CI: 0.05-5.02; P = 0.590) between the two groups.
Conclusion:
The mSVT was safe and effective for T2-3 thymic malignancies and could be an alternative for selected patients with locally advanced thymic diseases. Further prospective studies are needed to evaluate the long-term survival of modified subxiphoid approach thoracoscopic thymectomy.
[CITATION]: Xinyu Yang, Jiahao Jiang, Yongqiang Ao, et al. Perioperative Outcomes and Survival of Modified Subxiphoid VATS Thymectomy for T2-3 Thymic Malignancies: A Retrospective Comparison Study, The Journal of Thoracic and Cardiovascular Surgery, 2024 Apr 26.
[DOI]: 10.1016/j.jtcvs.2024.04.023.
[IF]: 6.0
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改良剑突下VATS 胸腺切除术治疗T2-3期胸腺恶性肿瘤的围手术期结局和生存率：一项回顾性比较研究
胸“星”外科学术团队成员 古明宇 译
目的
前期研究表明，在胸骨牵引器的辅助下，改良剑突下电视辅助胸腔镜胸腺切除术（modified subxiphoid VATS thymectomy, mSVT）可治疗局部浸润性胸腺恶性肿瘤。本研究旨在比较mSVT与胸骨正中切开胸腺切除术（median sternotomy thymectomy, MST）治疗局部晚期胸腺恶性肿瘤的围手术期和肿瘤学结局。
方法
本研究从一个前瞻性数据库中纳入了2015年至2020年间221例接受过mSVT或MST的T2-3期胸腺恶性肿瘤患者。采用1:1倾向评分匹配分析来平衡偏倚。手术难度通过改良切除指数评估。研究比较了mSVT组与MST组的围手术期和肿瘤学结局。
结果
在最终分析中，每组各有 72 例患者。研究结果显示，mSVT组的手术时间更短（98 分钟vs. 129 分钟 P< 0.001），失血量更少（40 毫升vs. 100 毫升, P< 0.001），引流时间更短（3 天vs. 5天, P< 0.001），住院时间更短（5 天vs. 6天, P< 0.001），术后并发症更少（5.6% vs. 23.6%; P= 0.005）。两组的完全切除率无显著差异（98.6% vs. 98.6%, P= 1.000）。有5例患者手术方式发生变化（5/106，4.7%）。生存分析显示，两组患者的无复发生存（HR= 0.94; 95% CI: 0.40-2.20; P=0.883）和总生存（HR= 0.52; 95% CI: 0.05-5.02;P= 0.590）相似。
结论
mSVT治疗T2-3期胸腺恶性肿瘤安全有效，可作为局部晚期胸腺疾病患者的替代疗法。未来还需要进一步的前瞻性研究对改良剑突下胸腔镜胸腺切除术的长期生存率进行评估。
Table 1. Baseline characteristics between the mSVT group and the MST group.
Figure 3. RFS and OS between mSVT and MST groups after PSM.
2017·EATTS
02
Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases
Jun Hee Lee1, Tae Hyun Park1, Hyun Koo Kim2
1 Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
2 Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Objective:
This study aimed to report the initial experiences of 115 patients who underwent robotic thoracic surgery using the da Vinci single-port robotic surgical system (Intuitive Surgical).
Methods:
Robotic thoracic surgery using the da Vinci single-port robotic surgical system was performed on 115 patients between November 2020 and June 2023. Patient characteristics, intraoperative outcomes, and postoperative outcomes were analyzed retrospectively.
Results:
The type of surgeries included thymectomy, mediastinal mass excision, anatomical pulmonary resection (including lobectomy and segmentectomy), esophagectomy, and enucleation of esophageal submucosal tumors in 41, 13, 54, 5, and 2 patients, respectively. The mean total operative time and chest tube duration for different procedures were as follows: thymectomy, 152.9. ± 6.7 minutes and 1.2 ± 0.5 days; mediastinal mass excision, 93.3 ± 26.5 minutes and 1.0 ± 0 days; anatomical pulmonary resection, 187.2 ± 55.8 minutes and 2.5 ± 1.5 days; esophagectomy, 485 ± 111.9 minutes and 12 ± 4.6 days; and enucleation of esophageal submucosal tumors, 170 ± 30 minutes and 5.5 ± 0.5 days, respectively. Conversion to a thoracotomy or sternotomy was not required. Conversion to video-assisted thoracic surgery occurred in 1 patient, and an additional port was applied in 2 patients. Two patients experienced postoperative complications greater than grade IIIa.
Conclusions:
Robotic thoracic surgery using the da Vinci single-port robotic surgical system is feasible and safe in various fields of thoracic surgery, including complex procedures such as anatomical pulmonary resection and esophagectomy. More complex thoracic surgeries can be performed with the continuous advancement and innovation of instruments in robotic systems.
[CITATION]: Lee JH, Park TH, Kim HK. Robotic thoracic surgery using the single-port robotic system: Initial experience with more than 100 cases. J Thorac Cardiovasc Surg. 2024 Apr 26:S0022-5223(24)00206-X.
[DOI]: 10.1016/j.jtcvs.2024.03.005
[IF]: 6.0
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单孔机器人系统在机器人胸腔镜手术中的应用：100余例手术的初步经验
胸“星”外科学术团队成员 张露丹 译
目的
方法
在2020年11月至2023年6月期间，使用达芬奇单孔机器人手术系统对115例患者进行机器人胸腔镜手术。回顾性分析了患者的特征、术中结局和术后结局。
结果
手术类型包括：胸腺切除术41例，纵隔肿块切除术13例，解剖性肺切除术（包括肺叶切除术和肺段切除术）54例，食管切除术5例，食管粘膜下肿瘤切除术2例。不同术式的平均手术时间和胸管留置时间如下：胸腺切除术，152.9±6.7分钟和1.2±0.5天；纵隔肿块切除术，93.3±26.5分钟和1.0±0天；解剖性肺切除术，187.2±55.8分钟和2.5±1.5天；食管切除术，485±111.9分钟和12±4.6天；食管粘膜下肿瘤切除术，170±30分钟和5.5±0.5天。无需转化为开胸或胸骨切开术。1例患者转化为电视辅助胸腔镜手术，2例患者使用双孔。2例患者术后并发症大于IIIa级。
结论
使用达芬奇单孔机器人手术系统的机器人胸腔镜手术在胸外科的各个领域均安全可行，包括解剖性肺切除术和食管切除术等复杂手术。随着机器人系统仪器的不断进步和创新，可开展更复杂的胸外科手术。
Figure 3. Subcostal uniportal robotic pulmonary resection using the da Vinci single-port robotic surgical system (Intuitive Surgical). A, Illustrations of subcostal single-port robotic pulmonary resection using the da Vinci single-port robotic surgical system. Note that the surgical assistant can insert an endoscopic stapler and other devices through the assistant port. B, Placement of robotic arms: Robotic arms 1 and 2 with Cadiere forceps and robotic arm 3 with Maryland bipolar forceps. C, Surgical view during dissection of the subcarinal lymph nodes in a right-sided tumor. Robotic arm 1 was used to apply traction to the lungs or tissues surrounding the lymph nodes. Robotic arm 2 holds the rolled-up gauze to apply traction to the lungs. Robotic arm 3 was used to perform the dissection.
Figure 5. Robotic thoracic surgery using the single-port robotic surgical system.
2017·EATTS
