ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
ObjectiveTo analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.MethodsA total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.ResultsOverall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.ConclusionThere is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.
ObjectiveTo systematically review the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for patients with non-small cell lung cancer (NSCLC). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 9, 2016), Web of Science, CNKI, VIP, WanFang Data and CBM databases to collect clinical studies about RATS vs. VATS for patients with NSCLC from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 cohort studies involving 19 921 patients were included; among them, 4 322 cases were in the RATS group, and 15 599 were in the VATS group. The results of meta-analysis showed that the operation time (MD=22.90, 95%CI 9.97 to 35.84, P<0.000 5) was longer in the RATS group than the VATS group. However, the conversion rate (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), the incidence of postoperative complications (OR=1.06, 95%CI 0.96 to 1.17, P=0.28), intraoperative blood loss (MD=2.75, 95%CI –8.39 to 13.89, P=0.63), postoperative hospitalization time (MD=–0.00, 95%CI –0.02 to 0.02, P=0.99) and in-hospital mortality rate (OR=0.60, 95%CI 0.35 to 1.05, P=0.07) were not significant differences between both groups.ConclusionThe current meta-analysis indicates that the efficacy and safety of RATS and VATS for NSCLC is equivalence, however the operation time for RATS is longer. Due to the limited quantity and quality of inclued studies, the above conclusions still need to be verified by more high quality studies.
ObjectiveTo investigate the clinical effect of three-port Da Vinci robot-assisted radical resection of lung cancer. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted radical resection of lung cancer in the Second Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University from April 2021 to March 2022 were retrospectively analyzed. According to the number of surgical ports, they were divided into two groups: a three-port group (three-port Da Vinci robot-assisted radical resection of lung cancer), and a four-port group (traditional Da Vinci robot-assisted radical resection of lung cancer). The operation time, intraoperative bleeding, lymphadenectomy, total thoracic drainage, extubation time, postoperative complications and postoperative pain of the two groups were compared and analyzed. ResultsA total of 58 patients were included, including 19 males and 39 females, aged 31-79 years. There were 21 patients in the three-port group, and 37 patients in the four-port group. The visual analogue scores on the first and third day after the operation were 4.33±1.20 points and 2.24±0.77 points in the three-port group, and 5.11±1.22 points and 2.78±1.06 points in the four-port group, and there were statistical differences between the two groups (P<0.05). There was no significant difference between the two groups in terms of operation time, intraoperative bleeding, lymph node dissection, postoperative thoracic drainage, time of thoracic tube insertion or postoperative complications (P>0.05). ConclusionThree-port Da Vinci robot-assisted radical resection of lung cancer can reduce the postoperative pain without increasing the operation difficulty and complications, and can be widely used in the clinical practice.
ObjectiveTo summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor.MethodsA retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed.ResultsAll the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489(26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000).ConclusionCompared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.
ObjectiveTo compare the differences in the learning curve and surgeon's perception for pulmonary lobectomy performed by a single surgeon using the da Vinci surgical robot versus a domestically-made robotic system. Methods A retrospective analysis was conducted on the clinical data of the first 70 consecutive patients who underwent lobectomy with the da Vinci robot and the first 70 with a domestic robot. All procedures were performed by a single thoracic surgeon at Gansu Provincial Hospital who initiated the use of both systems concurrently between 2021 and 2024. Data were analyzed using SPSS 26.0, and learning curves for both groups were plotted and analyzed using the cumulative sum (CUSUM) method. Results The da Vinci group included 41 males and 29 females with a mean age of (66.0±6.83) years and the domestic robot group included 42 males and 28 females;with a mean age of (65.09±6.14) years. For the da Vinci group, the mean operative time was (196.14±29.63) min. The CUSUM learning curve was best fitted by a cubic equation (R2=0.986; CUSUM=0.012X3?1.799X2+69.149X?59.239, where X was the surgical volume), which peaked at the 26th case, delineating the learning and mastery phases. Statistically significant differences were observed between these phases in operation time, setup time, console time, intraoperative blood loss, postoperative day 1 drainage, and number of lymph nodes dissected (all P<0.01). For the domestic robot group, the mean operative time was (187.57±24.62) min. Its CUSUM learning curve also followed a cubic fit (R2=0.910; CUSUM=0.008X3?1.152X2+40.465X+91.940), peaking at the 18th case. Significant improvements between the learning and mastery phases were also found for the same surgical metrics (all P<0.05). The surgeon's perception score was significantly higher for the da Vinci system compared to the domestic system (4.21±0.88 vs. 3.29±1.02, P<0.05). ConclusionCUSUM analysis effectively distinguishes the learning and mastery phases for both systems. The learning curve for da Vinci robotic lobectomy is overcome after 26 cases, whereas the domestic robot required 18 cases. In the mastery phase, operative time, setup time, intraoperative blood loss, and postoperative day 1 drainage are significantly lower, while the number of lymph nodes dissected is significantly higher compared to the learning phase for both systems. There are no significant differences in short-term efficacy or safety between the two groups. However, the da Vinci system provids a superior surgeon experience.
ObjectiveTo compare the perioperative outcomes between robot-assisted complex segmentectomy and simple segmentectomy for stage ⅠA non-small cell lung cancer (NSCLC). MethodsThe clinical data of 285 patients with NSCLC undergoing robot-assisted thoracic surgery (RATS) in our hospital from January 2015 to August 2021 were retrospectively analyzed. There were 105 males and 180 females aged 23-83 years. The patients were divided into a complex segmentectomy group (n=170) and a simple segmentectomy group (n=115) according to tumor location and surgical method. The clinical pathological baseline characteristics and perioperative outcomes between the two groups were compared, including operative time, blood loss volume, dissected lymph nodes, conversion rate, postoperative duration of drainage, postoperative hospital stay, the incidence of persistent air leakage and postoperative 30 d mortality. ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). No postoperative 30 d death was observed. One patient in the complex segmentectomy group was transferred to thoracotomy. No statistical difference was observed between the two groups in the operative time (97.36±38.16 min vs. 94.65±31.67 min, P=0.515), postoperative duration of drainage (3.69±1.85 d vs. 3.60±1.90 d, P=0.679), postoperative hospital stay (4.07±1.85 d vs. 4.05±1.97 d, P=0.957), dissected lymph nodes (5.15±3.53 vs. 5.13±2.93, P=0.952), incidence of blood loss volume<100 mL (98.2% vs. 99.1%, P=0.650), and incidence of postoperative persistent air leakage (6.5% vs. 5.2%, P=0.661). ConclusionThe safety and effectiveness of robot-assisted complex segmentectomy and simple segmentectomy are satisfactory in the treatment of stage ⅠA NSCLC. The perioperative results of RATS complex segmentectomy and simple segmentectomy are similar.
ObjectiveTo investigate the effect of pressure control ventilation-volume guaranteed (PCV-VG) for patients undergoing da Vinci robotic-assisted pulmonary lobotomy. MethodA total of 40 patients undergoing Da Vinci robotic-assisted pulmonary lobotomy were randomly divided into two groups:a PCV-VG group (G group) and a volume-controlled ventilation (VCV) group (V group). There were 20 patients in each group with 13 males and 7 females at age of 49.0±5.5 years in the G group, 16 males and 4 females at age of 51.0±3.9 years in the V group. Haemodynamics indexes and oxygenation parameters were recorded at different times and compared between the two groups. ResultsDuring one-lung ventilation (OLV) period, the peak inspiratory pressure (Ppeak), respiratory index (RI) and arterial partial pressure of carbon dioxide (PaCO2) in the G group were statistically lower than those in the V group (P<0.05). While the Cdyn and inspired oxygen fraction(OI) were higher in the G group than those in the V group (P<0.05). ConclusionCompared with the traditional VCV ventilation mode, the PCV-VG ventilation mode improves Ppeak, Cdyn, OI, and RI of the patients undergoing da Vinci robotic-assisted pulmonary lobotomy.
Objective To compare the clinical efficacy and safety of da Vinci robot with totally no tube (TNT) versus subxiphoid video-assisted thymectomy surgery (SVATS) in the treatment of thymic tumors. Methods From 2019 to 2021, a retrospective analysis was conducted on patients with thymic tumor resection in the Department of Thoracic Surgery, General Hospital of Northern Theater Command. All patients underwent total thymectomy and mediastinal fat removal, and they were divided into a TNT group and a SVATS group according to the operation method. The intraoperative blood loss, conversion rate, postoperative visual analogue score (VAS), postoperative hospital stay time and postoperative complications were compared between the two groups. Results We finally included 435 patiets. There were 168 patients with 83 males and 85 females at an average age of 61.920±9.210 years in the TNT group and 267 patients with 147 males and 120 females at an average age of 61.460±8.119 years in the SVATS group. There was no death or postoperative myasthenic crisis in both groups. There was no statistical difference in postoperative hospital stay (1.540±0.500 d vs. 3.400±0.561 d, P=0.000), intraoperative blood loss (13.450±5.498 mL vs. 108.610±54.462 mL, P=0.000), postoperative 24 h VAS score (4.960±1.757 points vs. 3.600±1.708 points, P=0.000), or postoperative complication rate (3.0% vs. 11.6%, P=0.001).Conclusion TNT is a more efficient, safe, and effective surgical approach for treating thymic tumors, which can shorten hospital stay time and reduce postoperative complications. However, SVATS can minimize postoperative pain.
ObjectiveTo compare the short-term outcomes of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracoscopic-laparoscopic minimally invasive esophagectomy (VAMIE) for esophageal cancer. MethodsA retrospective analysis was conducted on the data of patients with esophageal cancer admitted to Gansu Provincial People's Hospital from January 2021 to February 2025. Based on the surgical method, patients were divided into a RAMIE group and a VAMIE group. Both groups underwent standard McKeown three-incision surgery and systematic three-field lymph node dissection. Intraoperative blood loss, number of lymph nodes dissected, postoperative recovery indicators, and complication rates were compared. ResultsA total of 126 patients with esophageal cancer were included, of which 109 were male and 17 were female, with an average age of (64.6±8.8) years. The RAMIE group consisted of 36 patients and the VAMIE group 90 patients. There was no statistical difference in baseline indicators such as age, sex, and body mass index between the two groups (P>0.05). The difference in operation time between the two groups was not statistically significant [305.0 (280.0, 348.0) min vs. 300.0 (268.8, 340.0) min, P=0.457]. Compared with the VAMIE group, the RAMIE group had less intraoperative blood loss [100.0 (100.0, 120.0) mL vs. 100.0 (100.0, 200.0) mL, P=0.035], more intraoperative fluid infusion [(2244.7±610.3) mL vs. (1954.4±457.9) mL, P=0.013], a higher number of lymph nodes dissected [(27.9±10.6) nodes vs. (21.3±5.1) nodes, P<0.001], and the difference in the number of lymph node dissection groups was not statistically significant [8.0 (6.0, 8.0) groups vs. 7.0 (5.0, 8.0) groups, P=0.268]. In terms of postoperative recovery indicators, compared with the VAMIE group, the RAMIE group had shorter postoperative hospital stay [12.5 (9.0, 18.0) d vs. 17.0 (14.0, 22.0) d, P＜0.001] and shorter time with tubes [9.0 (8.0, 10.0) d vs. 10.0 (9.0, 12.0) d, P=0.007]. In terms of postoperative complications, the incidence of recurrent laryngeal nerve injury in the RAMIE group was significantly lower than that in the VAMIE group (2.8% vs. 16.7%, P=0.039), there was no statistical difference in pulmonary infection, anastomosis leakage, and incision infection between the two groups (P>0.05). The total hospitalization cost of the RAMIE group was significantly higher than that of the VAMIE group (P<0.001). ConclusionRAMIE has significant advantages over VAMIE in terms of intraoperative bleeding control, the number of lymph node dissections, postoperative recovery speed, and reducing the risk of incision infection and recurrent laryngeal nerve injury, with good safety and feasibility.