Experience Of Robotic Video Assisted Thoracic Surgery In Brazil.
Ricardo M. Terra1, RUI HADDAD2, José R. Milanez3, Pedro Henrique X.N. de Araújo1, Carlos E. Teixeira-Lima4, Felipe Braga4, Benoit Bibas3, Juliana M. Trindade5, Leticia L. Lauricella1, Paulo M. Pego-Fernandes1.
1Thoracic Surgery Division, Universidade de São Paulo, Hospital das Clínicas, Instituto do Coração e Instituto do Câncer do Estado de São Paulo, Hospital Sírio e Libanês e Hospital Israelita Albert Einstein, São Paulo - SP, Brazil, 2Hospital Copa Star and Rede D'Or, Escola Médica de Pós Graduação da Pontifícia Universidade Católica. (PUC-Rio), Rio de Janeiro - RJ, Brazil, 3Thoracic Surgery Division, Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Coração, Instituto de Câncer e Hospital Israelita Albert Einstein, São Paulo - SP, Brazil, 4Hospital Copa Star, Hospital Quinta D'Or and Rede D'Or, Rio de Janeiro - RJ, Brazil, 5Thoracic Surgery Division, Universidade de São Paulo, Instituto do Coração and Instituto do Câncer de SP, Faculdade de Medicina, Hospital das Clínicas e Hospital Sírio e Libanês, São Paulo - SP, Brazil.
BACKGROUND: Robotic video-assisted thoracic surgery (RVATS) is a new improved access for surgical treatment of thoracic diseases. Similarly to what happened to VATS several decades ago, it is now, after more than ten years since its introduction, finding its real and definitive path in thoracic surgery. In this paper we present our experience in robotic thoracic surgery in the past thirty-three months, being so far the largest Brazilian experience in this specialty. METHODS: we did a retrospective analysis of prospectively maintained databases of 2 groups of surgeons from São Paulo and Rio de Janeiro (Brazil) respectively, retrieving data addressing demography, diagnosis, duration of operation (in minutes) and mortality and morbidity of patients undergoing robotic surgery since the inception of our program in Mar/2015, until Dec/2017 (33 months). RESULTS: 157 consecutive patients were included in this study. There were 83 males and 74 females, the mean age was 60 years old (sd=17.7), 133 patients underwent pulmonary resections and 24 underwent resection of mediastinal lesions. The mean console time was 125 minutes for pulmonary resections and 82 minutes for mediastinal diseases. The lung resections performed were bilobectomy (1), lobectomies (113), anatomic segmentectomies (15), and wedge resections (4). The most common diagnosis was lung adenocarcinoma. There was no conversion to either VATS or thoracotomy in our series, as well as no major intraoperative bleeding or other lesions. Patients were discharged after one day (4 patients), two days (42), three days (42), four days (19), five days (10) and 6 or more days (34 - from 6 to 46 days). Postoperative complications occurred in 26 patients, and prolonged air leak was the most common (13 patients and 5 patients were discharged with Heimlich valve). There was only one fatality in an elderly patient who underwent lobectomy and coursed with pneumonia, sepsis and multiple organ failure. CONCLUSIONS: This is, so far, the largest Brazilian and probably Latin-American series of robotic thoracic surgery and the results we obtained were comparable to the results previously reported in the literature. RVATS is now a reality in our country and it is possible, with appropriate training and tutoring, to have good outcomes even during the learning curve. More studies addressing the cost of the procedure in an emerging country like ours are needed to validate RVATS as an excellent approach to our scenario.
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