The Progress Of Robotic Pulmonary Sleeve Resection And Ruijin Experience
Dong Dong, Hecheng Li.
Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BACKGROUND: Pulmonary sleeve resection (PSR) was first attempted in the 1940s and began to be utilized in the 1980s for the treatment of lung cancer. Nowadays, the development of video-assisted thoracic surgery (VATs) and robotic surgery system made it possible to perform PSR in a minimally invasive way. Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, as one of the earliest centers to perform robot-assisted thoracic surgery in China, has carried out more than 1,300 robotic lung cancer surgeries since May 2015, including robotic PSR (RPSR). This study aims to investigate the safety and efficacy of RPSR in the treatment of lung cancer by summarizing international studies along with the surgical experience of our center.
METHODS: A review of articles related to RPSR and summarize the results of RPSR performed at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine.
RESULTS: Since the first publication on the application of RPSR in 2011, a series of cases have been reported, indicating the safety and feasibility of this procedure. In 2019, Qiu et al. conducted a propensity score-weighted comparison between robotic, video-assisted and open PSR, which demonstrated that patients who underwent RPSR performed better in bleeding (P < .001), operative time (P < .001) and chest tube stay (P < .001) than the other two groups. A potential benefit of lymph node dissection (P = 0.003) was also observed in the RPSR group, according to another comparative study between RPSR and video-assisted PSR (Jin et al. 2022). Regarding long-term survival, the follow-up result of a cohort of 104 patients who underwent RPSR indicated a 73.0% OS rate and 67.9% DFS rate, which was similar to that of the VATs approach (Liu et al. 2022). Our center conducted 11 cases of RPSR from May 2015 to December 2022. The median operation time was 220 (range 167.5-283.5) min. The median length of postoperative hospital stay and chest tube stay was 8 (range 6.5-10.5) and 6 (4.5-8.5) days, respectively. There was no mortality or conversion after the surgery.
CONCLUSIONS: The series of studies and experience of our center showed that RPSR is a safe and feasible procedure for appropriate patients. Our limited experience demonstrates that operative time can be further shortened with the increase of experience in robotic surgery and the optimization of suture mode.
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