Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

Objective: Robot-assisted thoracoscopic (RATS) lung resection is a widely used treatment modality. We hypothesized that geographic and sociodemographic factors would affect trends in RATS use versus video-assisted thoracoscopic (VATS) for lung resection in the United States.

Methods: Retrospective study of patients who underwent either RATS or VATS lung resection from 2016 to 2020 within the National Inpatient Sample. Cohorts were stratified by extent (lobectomy vs sublobar) and technique (RATS vs VATS) of resection and compared with respect to sociodemographic, hospital-level, and geographic factors.

Results: From 2016 to 2020, 81,340 patients underwent lobectomy (35.8% vs 64.3% for RATS vs VATS) and 88,620 underwent sublobar resection (24.2% vs 75.8% for RATS vs VATS). RATS lung resection rates varied by year and geographic division (P < 0.05). The odds ratio (OR) of RATS for lobectomies (reference = East South Central) ranged from 1.64 (95% confidence interval [CI]: 1.35 to 2.0) for Pacific to 3.88 (95% CI: 3.23 to 4.67) for East North Central. For sublobar resection, they ranged from 1.64 (95% CI: 1.31 to 2.06) for Pacific to 3.27 (95% CI: 2.69 to 4.02) for South Atlantic. Race, ruralness, treatment year, age, admission status, hospital teaching status, and certain insurance types were independently associated with the odds of RATS lobectomy use (P < 0.05). Findings were similar for sublobar resection use, except for insurance status (P > 0.05) and hospital bed size (P < 0.05).

Conclusions: Geographic division remained independently associated with the odds of RATS lung resection after adjusting for sociodemographic factors. The overall rates of RATS use ranged from 16.9% to 44.7% for lobectomy and from 11.5% to 30.6% for sublobar lung resection between geographic regions.

Objective: Right anterior minithoracotomy (RAMT) and ministernotomy (MS) are established approaches for minimally invasive aortic valve replacement (MIAVR). There is no consensus about which technique offers better results.

Methods: A literature search was conducted in MEDLINE, Scopus, and Cochrane Library, focusing on studies that compared RAMT and MS for MIAVR. RevMan 8.13.0 (The Cochrane Collaboration, London, UK) was used to calculate effect estimates reported as odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).

Results: We included 21 studies with 6,986 patients, of whom 45.8% underwent RAMT. RAMT was associated with a shorter hospital stay (MD = -0.8 days, 95% CI: -1.4 to -0.2, P = 0.002) and reduced blood loss (MD = -22.3 mL, 95% CI: -32.8 to -11.8, P < 0.001), transfusion rates (OR = 0.7, 95% CI: 0.5 to 0.9, P = 0.01), and incidence of acute kidney injury (AKI; OR = 0.7, 95% CI: 0.5 to 0.9, P = 0.02). However, RAMT was also associated with a slightly longer cardiopulmonary bypass (CPB) time (MD = 9.0 min, 95% CI: 0.7 to 17.3, P = 0.03, I² = 97%) and incisional pain score (standardized MD = 0.5, 95% CI: 0.4 to 0.6, P < 0.001). Mortality, stroke, and other complications were similar between the 2 techniques.

Conclusions: RAMT offers advantages including shorter hospital stay and reduced blood loss, transfusion, and AKI rates but at the cost of slightly longer CPB time and greater incisional pain. These findings underscore the need for individualized patient selection based on surgical risk, anatomical considerations, and recovery priorities.