Feasibility and quality control of robotic sleeve lobectomy and bronchoplasty_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xilong , XU Shiguang , LIU Bo , WU Ziheng , LIU Deyu , XU Wei , WANG Bin , DING Renquan , LIU Xingchi ,  WANG Shumin

Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Bronchoplasty; sleeve lobectomy; minimally invasive; robotic

DOI：

10.7507/1007-4848.201910056

Video：

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Objective To explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management.Methods From January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped.Results The operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications.Conclusion Since the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.

Citation： WANG Xilong, XU Shiguang, LIU Bo, WU Ziheng, LIU Deyu, XU Wei, WANG Bin, DING Renquan, LIU Xingchi, WANG Shumin. Feasibility and quality control of robotic sleeve lobectomy and bronchoplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 190-194. doi: 10.7507/1007-4848.201910056 Copy

1.	嵇武, 李宁, 黎介寿. 我国手术机器人外科面临的机遇和挑战. 中国微创外科杂志, 2012, 12(7): 577-579.
2.	王述民, 许世广, 童向东, 等. 机器人肺叶切除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2013, 20(3): 308-311.
3.	王述民, 童向东, 刘博, 等. 达芬奇机器人左肺上叶切除术和淋巴结清除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2015, 22(3): 215-219.
4.	Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. J Thorac Dis, 2016, 8(9): 2454-2463.
5.	张大坤, 许世广, 丁仁泉, 等. 达芬奇机器人手术与胸腔镜辅助小切口手术对肺手术患者创伤对比分析. 创伤与急危重病医学, 2014, 2(5): 296-300.
6.	王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.
7.	Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
8.	许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
9.	Tronc F, Gregoire J, Deslauriers J. Bronchoplasty. In: Patterson G, Cooper J, Deslauriers J, et al, eds. Pearson’s Thoracic & Esophageal Surgery. 3rd ed. Phila-delphia, PA: Churchill Livingstone Elsevier, 2008. 894–908.
10.	Santambrogio L, Cioffi U, De Simone M, et al. Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report. Chest, 2002, 121(2): 635-636.
11.	Mahtabifard A, Fuller CB, McKenna RJ Jr. Video-assisted thoracic surgery sleeve lobectomy: a case series. Ann Thorac Surg, 2008, 85(2): S729-S732.
12.	刘伦旭, 梅建东, 蒲强, 等. 全胸腔镜支气管袖式成形肺癌切除的初步探讨. 中国胸心血管外科临床杂志, 2011, 18(5): 387-389.
13.	刘鸿程, 朱余明, 姜格宁, 等. 全胸腔镜右肺上叶切除支气管袖式成形2例. 中华胸心血管外科杂志, 2011, 27(10): 618.
14.	Gu C, Pan X, Chen Y, et al. Short-term and mid-term survival in bronchial sleeve resection by robotic system versus thoracotomy for centrally located lung cancer. Eur J Cardiothorac Surg, 2018, 53(3): 648-655.
15.	Cerfolio RJ. Robotic sleeve lobectomy: technical details and early results. J Thorac Dis, 2016, 8(Suppl 2): S223-S226.
16.	Ishikawa N, Sun YS, Nifong LW, et al. Thoracoscopic robot-assisted bronchoplasty. Surg Endosc, 2006, 20(11): 1782-1783.
17.	Schmid T, Augustin F, Kainz G, et al. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg, 2011, 91(6): 1961-1965.
18.	王希龙, 许世广, 刘博, 等. 达芬奇机器人与胸腔镜辅助小切口手术患者术后疼痛的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(3): 230-233.
19.	许世广, 王希龙, 童向东, 等. 机器人与电视胸腔镜手术治疗纵隔支气管源性囊肿的对比研究. 中国微创外科杂志, 2015, 15(3): 193-196.
20.	梅建东, 蒲强, 马林, 等. 全胸腔镜支气管袖式成形肺癌切除的流程设计与优化. 四川大学学报(医学版), 2013, 44(1): 114-118.
21.	Nakanishi R, Yamashita T, Oka S. Initial experience of video-assisted thoracic surgery lobectomy with partial removal of the pulmonary artery. Interact Cardiovasc Thorac Surg, 2008, 7(6): 996-1000.
22.	Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty: an improved operative technique. Eur J Cardiothorac Surg, 2013, 44(6): 1108-1112.
23.	李运, 李剑锋, 王俊. 全腔镜支气管袖式切除术. 中华胸心血管外科杂志, 2012, 28(9): 513-515.
24.	蒋伟, 奚俊杰, 王群, 等. 全胸腔镜肺癌根治术淋巴结清扫的探讨. 中国微创外科杂志, 2012, 12(11): 969-972, 975.

1. 嵇武, 李宁, 黎介寿. 我国手术机器人外科面临的机遇和挑战. 中国微创外科杂志, 2012, 12(7): 577-579.
2. 王述民, 许世广, 童向东, 等. 机器人肺叶切除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2013, 20(3): 308-311.
3. 王述民, 童向东, 刘博, 等. 达芬奇机器人左肺上叶切除术和淋巴结清除术治疗非小细胞肺癌. 中国胸心血管外科临床杂志, 2015, 22(3): 215-219.
4. Velez-Cubian FO, Rodriguez KL, Thau MR, et al. Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. J Thorac Dis, 2016, 8(9): 2454-2463.
5. 张大坤, 许世广, 丁仁泉, 等. 达芬奇机器人手术与胸腔镜辅助小切口手术对肺手术患者创伤对比分析. 创伤与急危重病医学, 2014, 2(5): 296-300.
6. 王述民. 达芬奇机器人在肺癌根治术中的应用现状及展望. 中国肿瘤, 2014, 23(9): 736-742.
7. Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg, 2012, 93(5): 1598-1604.
8. 许世广, 刘星池, 王希龙, 等. 应用达芬奇机器人手术系统肺切除技术总结. 中华胸部外科电子杂志, 2016, 3(2): 77-82.
9. Tronc F, Gregoire J, Deslauriers J. Bronchoplasty. In: Patterson G, Cooper J, Deslauriers J, et al, eds. Pearson’s Thoracic & Esophageal Surgery. 3rd ed. Phila-delphia, PA: Churchill Livingstone Elsevier, 2008. 894–908.
10. Santambrogio L, Cioffi U, De Simone M, et al. Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report. Chest, 2002, 121(2): 635-636.
11. Mahtabifard A, Fuller CB, McKenna RJ Jr. Video-assisted thoracic surgery sleeve lobectomy: a case series. Ann Thorac Surg, 2008, 85(2): S729-S732.
12. 刘伦旭, 梅建东, 蒲强, 等. 全胸腔镜支气管袖式成形肺癌切除的初步探讨. 中国胸心血管外科临床杂志, 2011, 18(5): 387-389.
13. 刘鸿程, 朱余明, 姜格宁, 等. 全胸腔镜右肺上叶切除支气管袖式成形2例. 中华胸心血管外科杂志, 2011, 27(10): 618.
14. Gu C, Pan X, Chen Y, et al. Short-term and mid-term survival in bronchial sleeve resection by robotic system versus thoracotomy for centrally located lung cancer. Eur J Cardiothorac Surg, 2018, 53(3): 648-655.
15. Cerfolio RJ. Robotic sleeve lobectomy: technical details and early results. J Thorac Dis, 2016, 8(Suppl 2): S223-S226.
16. Ishikawa N, Sun YS, Nifong LW, et al. Thoracoscopic robot-assisted bronchoplasty. Surg Endosc, 2006, 20(11): 1782-1783.
17. Schmid T, Augustin F, Kainz G, et al. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg, 2011, 91(6): 1961-1965.
18. 王希龙, 许世广, 刘博, 等. 达芬奇机器人与胸腔镜辅助小切口手术患者术后疼痛的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(3): 230-233.
19. 许世广, 王希龙, 童向东, 等. 机器人与电视胸腔镜手术治疗纵隔支气管源性囊肿的对比研究. 中国微创外科杂志, 2015, 15(3): 193-196.
20. 梅建东, 蒲强, 马林, 等. 全胸腔镜支气管袖式成形肺癌切除的流程设计与优化. 四川大学学报(医学版), 2013, 44(1): 114-118.
21. Nakanishi R, Yamashita T, Oka S. Initial experience of video-assisted thoracic surgery lobectomy with partial removal of the pulmonary artery. Interact Cardiovasc Thorac Surg, 2008, 7(6): 996-1000.
22. Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty: an improved operative technique. Eur J Cardiothorac Surg, 2013, 44(6): 1108-1112.
23. 李运, 李剑锋, 王俊. 全腔镜支气管袖式切除术. 中华胸心血管外科杂志, 2012, 28(9): 513-515.
24. 蒋伟, 奚俊杰, 王群, 等. 全胸腔镜肺癌根治术淋巴结清扫的探讨. 中国微创外科杂志, 2012, 12(11): 969-972, 975.

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