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The Use of Robotics for the Pleurectomy Phase of Extrapleural Pneumonectomy for Malignant Mesothelioma
M. Moslemi, D. Nguyen, B. Rawashdeh, M. Meyer, B. Tempesta, R. Poston, F. Gharagozloo
University of Arizona, Tucson, AZ, USA.

Objective: The pleurectomy phase of the extrapleural pneumonectomy is associated with significant blood loss and difficulty in clearing tumor from the apex as well as the costophrenic recess. This intrinsic blood loss results in increased transfusion rates with increased risk for the remaining lung to have post transfusion injury. We hypothesize that robotic technology, due to its ability to provide magnified high definition three dimensional visualization, and greater instrument maneuverability in confined spaces, could potentially obviate these difficulties.
Methods: Over a six month period, we reviewed patients planned for extrapleural pneumonectomies with robotic assisted pleurectomy. Blood loss was measured by transfusion requirement. Tumor clearance was subjectively graded by the surgeon.
Results: 5 patients were planned for robotic assisted extrapleural pneumonectomy. Two of these patients were deemed unresectable after robotic exploration. The remaining 3 patients that completed this procedure were 3 men. Median intraoperative blood loss was 200ml. There were no intraoperative transfusion requirements, though two patients required 2 units of packed red blood cells for drift hematocrit. Surgeon grading of tumor clearance was R0 in all four patients, R1 or R2 in no patients. Median operative time was seven 7 hours, 17 minutes. Median hospitalization days were 13 days. Thirty day survival was 100%.
Conclusion: Robotic technology allows for pleurectomy with decreased blood loss and increased clearance of tumor from areas too difficult to remove otherwise. This may improve outcomes for extrapleural pneumonectomy.

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