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International Society For Minimally Invasive Cardiothoracic Surgery

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Catastrophes In Robotic Thoracic Surgery: Intraoperative Evaluation And Management Of Adverse Events
Carmelina C. Zirafa, Gaetano Romano, Diana Bacchin, Federico Davini, Franca Melfi
University of Pisa, pisa, Italy

OBJECTIVE In recent years, a continuous growth of robotic procedures for the treatment of non small cell lung cancer (NSCLC) has been observed. Several studies have demonstrated the safety, feasibility and favourable postoperative outcomes of robotic technique. Consequently, the management of adverse event during robotic procedure can be considered a relevant current topic. METHODS We retrospectively analyzed any intra-operative adverse occurred in patients undergoing robotic major lung resection from June 2015 to December 2018. RESULTS Over the 271 major lung resections performed by a skilled robotic thoracic surgeon by robotic technique ,in 5 cases (1.8%) an intraoperative adverse event occurred. Details of these adverse events cases were collected and analyzed, to perceive possible risk factors. The 5 intraoperative disasters consisted of arterial injury, in 3 cases a conversion in thoracotomy was done. Intraoperative adverse events were observed in 2.5% of men and in 0.9% of women, with an average age of 70.8 years (range 65-80), similar to the average age of the entire group of patients analyzed (67,7 years). A higher incidence of surgical injury was recorded in left upper lobectomy (2/50), in right upper lobectomy (2/84) and in right lower lobectomy (1/46). We observed intraoperative adverse events in 3.8% of patients with squamous cells carcinoma and in 0.1% of patients with adenocarcinoma. None of the 5 patients received previous chemoradiotherapy. In our experience, a higher incidence of intraoperative complications in the month of December was detected (4/5) (Fig 1). CONCLUSIONS In our series, the male sex, the squamous cell carcinoma histology and the left upper lobectomy appear to be associated with an increased risk of surgical catastrophe. Higher levels of stress on the surgeon could explain the augmented incidence of surgical injury in the last period of the year. The presence of a skilled robotic team is outermost fundamental to reduce complications and their affinity appear crucial in the prompt management of the adverse event.Analysis of predictive factors and technical progress will be subject to further studies. LEGEND: Trend of operations and intraoperative catastrophes during the year



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