Benefits Of Robotic Approach For Pulmonary Lobectomy In Tb Patients
Piotr Yablonskii, Grigorii Kudriashov, Armen Avetisyan, Larisa Kiryukhina, Olga Sokolova
St. Petersburg State Research Institute of Phthisiopulmonology,, Saint Petersburg, Russian Federation
BACKGROUND:robot-assisted approach became a modern approach in general thoracic surgery and oncology for pulmonary resections.At the same time, less evidence of its benefits in comparison to VATS and muscle sparing thoracotomy does not allow the widespread use of new technology, including for infectious lung diseases.This led to a study of the efficacy and safety of the three main approaches to pulmonary tuberculosis surgery: RATS,VATS and muscle sparing thoracotomy.METHODS:190 consecutive patients (121/64%males) with localized single-sided pulmonary tuberculosis were included.60 pts(32%) had persistent positive sputum smears on MTB and 144pts(76%) had persistent cavity in lung despite adequate antituberculosis chemotherapy. Drug resistance of MTB was registered in 117cases(61%) preoperatively. Physical status was2±1(ASA), CCI was1±1, FEV1was94±17%.All patients were selected for pulmonary lobectomy according WHO consensus statement(2014).Open lobectomies(muscle sparing lateral thoracotomy)were performed in86cases(45%)and minimally-invasive lobectomies were performed in104cases(55%)(RATS-71pts/38%,VATS-33pts/17%).Intraoperative and early postoperative surgical outcomes were investigated.Nonparametric statistical methods were used(U-test,Kruskal-Wallis and Chi-squared tests).RESULTS:learning curve of robotic lobectomy was35operations.Perioperative data before and after learning curve showed in table. Robotic approach in comparison to VATS was associated with less operative time(167±65vs208±68 min.,p=0.001)and intraoperative blood loss(66±84ml vs 89±79ml,p=0.031).Robotic approach in comparison to thoracotomy was associated with the same operative time, less intraoperative blood loss(66±84ml vs 124±107ml,p=0.0001)and shorter period of chest drainage(5,8±5 days vs 9,0±11,2, p=0.002).Conversion rate was4%and6%for RATS and VATS respectively(p=0.684). There were not statistical differences in postoperative morbidity between groups(14%,12%,20%for RATS,VATS and open approaches respectively).CONCLUSIONS:robotic approach associated with better postoperative outcomes.Additional randomized trials are necessary for the final evidence.
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