Port Placement Of Robotic Assisted Lobectomy
Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Background: Robotic-assisted thoracic surgery (RATS) is widely used for lung cancer in the world. There are many different robotic approaches, we analyze the differences between RATS lobectomy and systematic lymph nodes dissection for patients with lung cancer, especially discuss their approaches. Methods: We always used a 4 portal robotic pulmonary resection procedure using a CO2 insufflation system(-8cm) and 12 mm, 30° angled down the scope. Usually, the right forceps was a Maryland forceps (bipolar electrical cautery), the left hand was a Fenestrated forceps(bipolar soft coagulation), and more one arm was a Cadiere forceps on the backside. Cases were divided into 2 groups: A group: the lower port group (25 cases) and B group: the mid port group (21 cases). We always used the same 4-arm ports. Group A: The three ports (containing a camera) and the assist port were placed along with the 8th intercostal space and the first port is the 6th intercostal space and anterior axillary line. Group B: The three ports (containing a camera) were placed along with the 5th-6th intercostal space and the 3rd arm and the assist port is 8th intercostal space (Posterior and anterior axillary line). Comparisons between groups were performed using the chi-squared test for categorical data, and the Mann-Whitney U test for nonparametric data. Results: Total surgical time (218±27, 166±21min, P<0.001), console time (148±39, 128±26 P<0.001) were different significantly, B group is superior to A group. In A group, the direction of a stapler was not suitable to incise a pulmonary artery through the assist port, double port (from 8mm to 12mm) was needed for insertion of the stapler. While in B-group, it was difficult to incise pulmonary ligament in some cases, it needed to change forceps at 2nd and 3rd ports each other. Conclusions: Each of these port-placement has its merits and demerits. In our institute, the mid port group was suitable.
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