To compare the perioperative safety and short-term efficacy between robot- and video-assisted thoracoscopic lung cancer surgery based on propensity scores matching.

The clinical data were from 286 patients with primary lung cancer undergoing lobectomy or sublobectomy and lymph node dissection or sampling in the Department of Thoracic Surgery, Qilu Hospital of Shandong University from August 2020 to October 2020. Among them, 130 cases underwent Da Vinci robot-assisted thoracic surgery (RATS) , while 156 cases underwent video-assisted thoracic surgery (VATS) . The perioperative data were compared after controlling confounding factors by propensity score matching.

Eighty-eight cases in each group were successfully matched by propensity score matching analysis. The operational time of the RATS group was slightly longer than that of the VATS group , the difference was not statistically significant (P=0.625) . The intraoperative blood loss in the RATS group was less than that in the VATS group (P<0.001) . The number of lymph node dissection stations (P<0.001) and the number of lymph node dissections (P=0.031) in the RATS group were higher. In terms of hospitalization expenses, the RATS group was higher than that compared with the VATS group (P<0.001) . There was a statistically significant difference in the results of the NRS score after operation (P<0.001) , and the NRS score was higher. There were no statistically significant differences in lymph node ascending rate, time of drainage, drainage, hospital stay after operation, and postoperative complications (P>0.05) .

RATS has similar perioperative safety and short-term efficacy to VATS in resectable lung cancer. RATS has advantages in intraoperative blood loss and lymph node dissection. The disadvantage is the increased hospitalization cost and postoperative pain.

To report the experience of pretreatment-facilitated robot intrathoracic layered anastomosis (PRILA) .

Patients with esophageal cancer proved by biopsy and willing to accept robot-assisted minimally invasive esophagectomy (RAMIE) were included in this study. The pretreatments before anastomosis included the following procedures. Firstly, we used the sternal angle as a marker to confirm the length of the gastric conduit so that we could construct the conduit outside the body. Secondly, cold scissors, rather than the electrocoagulation equipment, were used in making the gastrostomy. Thirdly, the gastric conduit was carefully packaged with single-layered gauze before we move it into the thoracic cavity. Lastly, an intrathoracic clamp was placed on the proximal esophageal stump to reduce the bleeding of the stump. An interview was performed every half-year after the surgery to track the postoperative outcomes.

Between September 2018 and July 2019, 12 patients with esophageal cancer received PRILA for tumor resection and digestive tract reconstruction. All the patients achieved R0 resection, and no patient suffered from an anastomotic leakage. The mean length of postoperative stay was 9.9 day. All patients could receive semiliquid diet when discharged. No relapse or metastasis happened in the first year after the surgery.

PRILA is a safe and feasible procedure with favorable surgical outcomes. The pretreatment procedures provide us a clean surgical field so that the anastomosis could be performed fluently and accurately. It provides surgeons a new strategy to handle the challenges of the intrathoracic robotic anastomosis.

Since the first reported clinical application of robot-assisted minimally invasive esophagectomy (RAMIE) in the early 2000s, RAE has gained increasing popularity worldwide in the recent 20 years. Although RAE is not yet regarded as standard surgical treatment for esophageal cancer, a lot of institutions have reported the safety and feasibility of robotic system in both transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE). Most of the studies focused on the surgical outcomes and recent oncologic results, the RAMIE have shown with short blood loss and effective early oncologic outcomes: R0 resection rate approximately 95% and rare locoregional recurrence. This may show that RAMIE has a tendency of improved long-term survival for esophageal cancer. Thus, the objective of this study is to report the early oncological control results of robot assisted esophagectomy, based on the previous publications and our initial experience.

In recent years, with the development of Da Vinci robotic technology on the surgical treatment of esophageal cancer, the advantages of this technology were accepted by more and more esophageal surgeons, and its safety and efficacy are gradually recognized. Robot technology can be combined with traditional thoracoscopic or laparoscopic surgery and open surgery to complete the operation of different surgical approach. The advantages of robot technology can also be fully utilized to reduce the difficulty of surgery, especially on upper mediastinal space which are difficult to perform quickly and safely under traditional techniques. The aim of this article was to summarize the reports on the experience of robot-assisted minimally invasive esophagectomy(RAMIE), and to analyze the characteristics of different treatments of esophageal cancer in each center on surgical path and robot-assisted mode.

Robot-assisted minimally invasive esophagectomy(RAMIE)has the same safety and efficacy as traditional open surgery and thoracoscopic-laparoscopic esophagectomy, and is increasingly used in clinical operations. However, unplanned intraoperative events will inevitably occur in the early stage of RAMIE. In this paper, the types, occurrence rates and treatment methods of unplanned events in RAMIE are described, and the classification and treatment strategies of postoperative complications are also sorted out, so as to improve the understanding of intraoperative unplanned events and complications in RAMIE, to avoid unplanned events and reduce the harm caused by unplanned intraoperative events and serious complications as far as possible.

With the rapid development of DaVinci robot technology worldwide, it has been applied as a minimally invasive approach for esophagectomy in recent years. Despite the broad prospects of this type of surgery, it also brought greater challenge to thoracic surgeons. Until now, there are few reports on the DaVinci robotic system for esophagectomy , even fewer on its learning curve. The aim of this study was to summarize the research reports and explore the characteristics of learning curve for robot-assisted minimally invasive esophagectomy(RAMIE), which can be applied to guide the application of robotic surgery.

To analyze the perioperative parameters of non-small cell lung cancer patients who underwent robotic assisted lobectomy and summarize the surgical experience.

Retrospective review was conducted on 389 consecutive patients who underwent robotic-assisted lobectomy for clinical stage Ⅰ to Ⅲa of non-small cell lung cancer at Shanghai lung Tumor Clinical Medical Center, Shanghai Chest Hospital between May 2013 and December 2016. The maximum diameter of tumor on preoperative chest CT scan was(1.3±0.6)cm; 153 cases were in clinical stage Ⅰa, 148 in Ⅰb, 32 in Ⅰc, 6 in Ⅱb, 30 in Ⅲa; and the position of lesions for 37 cases was in left upper lobe, 101 in left lower lobe, 105 in right upper lobe, 32 in right middle lobe, 114 in right lower lobe; there were 380 cases of adenocarcinoma , and 9 cases of squamous carcinoma. Perioperative parameters and total hospital cost were analyzed.

The average operative time of all 389 RATS lobectomy was(91.5±30.8)min; 95.8 % of patients’ estimated intraoperative blood loss were less than 100 ml; the conversion rate was 1.2% (4 cases); no patient received blood transfusion and no 30-day postoperative mortality occurred. All patients underwent systematic lymphadenectomy, and the average station and number of lymph nodes dissected were(5.7±1.5)and (9.8±3.4)respectively. The mean volume of chest tube drainage on the first postoperative day was(231.4±141.9)ml; the drainage period was (4.0±1.5)d and no patient was discharged with chest tube; the average postoperative hospital stay was(5.0±1.5)d; postoperative air leak was the primary complication, accounting for 9.0%. The mean total hospital costs (self pay + insurance coverage) was(93 809.23±13 371.26)Yuan.

Da Vinci surgical robotic system is safe and effective for the treatment of operable NSCLC, and it can overcome many disadvantages of traditional VATS.

To review the outcomes of robot-assisted esophagectomy (RAE) for esophageal cancer in Shanghai Chest Hospital, and present the learning curve experience.

The clinical data of 75 patients undergoing RAE for esophageal cancer between November 2015 and August 2016 in Shanghai Chest Hospital were reviewed. The demographics, preoperative staging, surgical procedure, resection results and postoperative outcomes were analyzed.

Among these 75 patients, 53 were males and the other 22 were females, with the mean age of (62.1±8.0)years. Preoperative induction took place in 4 patients(5.3%). The R0 resection rate was 97.3%(73/75). The mean volume of blood loss was (230.7±73.5) ml. The mean total operation time of all patients was (275.2±56.8) min, and the mean thoracic operation time was (95.6±27.5) min. The total operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(318.0±48.1) min vs(259.7±51.8) min, t= 4.391, P<0.001]. The thoracic operation time of the former 20 cases was significantly longer than that of the latter 55 cases[(115.1±29.0) min vs(88.6±23.5) min, t= 4.057, P=0.001]. The mean number of lymph node dissection was 15.9±11.0, the number of thoracic lymph node dissection was 9.8±6.9, and the number of recurrent laryngeal nerve lymph node dissection was 3.3±2.6. When subgrouping according to operation sequencesof 1-20, 21-40, 41-60 and 61-75, the lymph node sampling rates of upper mediastinum were 85.0%, 100.0%, 100.0% and 100.0%, respectively(χ²=8.594, P=0.049), and the lymph node sampling rates along left recurrent laryngeal nerve were 65.0%, 95.0%, 95.0% and 100.0%, respectively(χ²=13.920, P=0.006). The main complications were respiratory failure(5 cases, 6.7%), chylothorax (2 cases, 2.7%), tracheo-esophageal fistula(1 case, 1.3%), pulmonary embolism(1 case, 1.3%) and vocal cord paralysis(VCP)(11 cases, 14.7%). When subgrouping according to operation sequencesof 1-25, 26-50 and 51-75, the incidence of VCP decreased without significant difference(24.0%, 12.0% and 8.0%; χ²=2.770, P=0.250). The median length of hospital stay was 12 d, and there was no 30-day mortality.

RAE is a safe and feasible alternative for treatment of esophageal cancer, which can improve the efficacy of lymph node dissection, especially for the lymphadenectomy along recurrent laryngeal nerve. The ability to execute a safe thoracicesophagectomy with complete mediastinal lymphadenectomy during RAE is improved over time, plateauing after the first 20 cases.

To summarize the experience in lobectomy with Da Vinci robotic surgical system.

The clinicaldataof 206 patients with lung cancer undergoing lobectomy with Da Vinci robotic surgical system between March 2012 and November 2015 in Department of Thoracic Surgery, General Hospital of Shenyang Military Area Command were retrospectively analyzed. Among these patients, 120 were males and 86 were females, and the mean age was 61 years. The data were statistically explored by year, and the learning curve of robotic lobectomy was analyzed.

All cases completed lobectomy and lymph node dissection with Da Vinci robotic surgical system. Among the 206 cases, there were right upper lobectomy in 58 cases, right lower lobectomy in 48 cases, right medium lobectomy in 11 cases, left upper lobectomy in 35 cases, left lower lobectomy in 53 cases, and both left upper lesion resection and right upper lobectomy in the other case. Three cases performed an additional small incision to repair the ruptured pulmonary artery. There was no transfer to open chest surgery. The postoperative pathological examinationindicated there were 157 cases of adenocarcinoma(including both sides of the case undergoing both left upper lesion resection and right upper lobectomy), 17 cases of squamous cell carcinoma, 19 cases of adenosquamous carcinoma, 7 cases of small cell lung cancer, and 6 cases of other findings. There was no perioperative death.

Lobectomy with Da Vinci robotic surgical system is safe and effective, and a good teamwork can lead to a better result.