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VATS and RATS lobectomy: what access is better for pulmonary tuberculosis?
Peter Yablonskii, Grigorii Kudriashov, Sabriddin Nuraliev, Igor Vasilev, Armen Avetisyan.
Saint-Petersburg Research Institute Phthisiopulmonology, Saint-Petersburg, Russian Federation.

OBJECTIVE: Surgery of pulmonary tuberculosis associated with dense pleural and vascular adhesions and treatment has traditionally been with open thoracotomy. These reasons limited the use of minimally invasive surgery in these cases (Han Y., 2015). Robotic surgery aimed to improving the quality of surgery and learning curve of minimally invasive operations. Advancements of RATS lobectomy for pulmonary tuberculosis are unknown.
Objective: to compare video-assisted thoracoscopic surgery (VATS) lobectomy and robotic-assisted lobectomy (RATS) in patients with pulmonary tuberculosis.
METHODS: Methods
Nineteen consecutive patients with tuberculous lessons (median age 44 years, range 15-69 years; median CCI 1.5, range 0-4; median FEV1 100, range 72-124; median BMI 23, range 18-35) separated into two groups according to surgical access: RATS or VATS. The indications for surgery were: persistent cavity in 5 cases, suspicion of neoplasm in 6 cases, positive sputum smear on MTB in 2 cases, multiply tuberculomas in the limits of one lobe in 6 cases. Patient pulmonary function, operative, and postoperative data compared between the groups.
RESULTS: There were 9 patients who successfully underwent VATS lobectomy and 10 that underwent RATS lobectomy. The two groups were similar with respect to gender, age, BMI, pulmonary function, pleural adhesions, severity of emphysema and comorbidities (all, P>0.05). The median operative time was 241 and 186 min., intraoperative blood loss was 137 and 107 ml (VATS and RATS groups respectively). The median duration of postoperative air leak was longer after VATS lobectomies (6.8 vs 1.8 days). The operation time, intraoperative blood loss, number of postoperative complications, duration of postoperative analgesia with narcotic analgesics were all significantly less in the RATS group. Postoperative rate of conversion of sputum smear in MTB - positive patients were 100%.
CONCLUSIONS: Robotic technology allows to operate patients with pulmonary tuberculosis is not less effective than VATS. RATS provides better operative and postoperative data’s in compare with VATS.

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