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

In endoscopic mitral valve repair and replacement, direct valve sizing is impractical because skin incisions have become very small and do not fit traditional sizers. Until now, procedure planning using dedicated computed tomography (CT) software has not been the standard of care. However, proper CT analysis can help anticipate procedural challenges and enhance procedure planning in endoscopic mitral valve surgery. Cannulation and valve implantation strategy may be chosen, risk of injury to the circumflex artery as well as left ventricular outflow tract obstruction may be anticipated, and digital phantoms of surgical prostheses may be simulated inside the annulus. We propose digital simulation and procedure planning for surgeons by CT-based reconstructions.

Objective: Previous studies have evaluated the feasibility of robot-assisted thoracoscopic segmentectomy (RVATS) in comparison with video-assisted thoracoscopic segmentectomy (VATS). We report both short-term and long-term outcomes comparing RVATS and VATS at a single institution.

Methods: This is a retrospective propensity-matched cohort study reviewing RVATS and VATS for primary non-small cell lung cancer (NSCLC) performed from 2013 to 2021 at our institution; 1:2 propensity matching was performed.

Results: There were 108 patients who underwent RVATS and 370 who underwent VATS for primary lung cancer. After propensity matching, we had 2 well-matched cohorts of 102 patients in the RVATS group and 204 in the VATS group. Our data showed no significant difference in 90-day mortality, 30-day hospital readmission rate, or median number of lymph nodes between the RVATS and VATS groups. There was also no significant difference in postoperative morbidity except for pleural effusion. RVATS had a significantly greater median number of lymph node stations harvested and longer operative time. Although both groups achieved R0 resections in all patients, RVATS showed a greater negative tumor margin distance compared with VATS. There was no significant difference in disease-free survival or overall survival between the 2 groups at 3 years.

Conclusions: In our experience, RVATS showed a greater number of lymph node stations harvested and greater negative tumor margin distance without compromising perioperative and oncological outcomes for segmentectomy performed for NSCLC.

Objective: Although robotic cardiac surgery is becoming more widely adopted for mitral valve procedures, robot-assisted tricuspid valve (TV) surgery is less common. We describe clinical and echocardiographic outcomes for 70 isolated and concomitant TV repair (TVr) cases.

Methods: Patients who underwent robotic totally endoscopic TV surgery at our institution were retrospectively reviewed. The da Vinci Si or Xi robot (Intuitive Surgical, Sunnyvale, CA, USA) was used for all cases, employing an 8 to 10 mm working port and using cardiopulmonary bypass on a beating heart. Early and midterm outcomes were reviewed, along with echocardiogram results when available.

Results: Between 2014 and 2024, 70 patients underwent TVr. Fourteen cases were isolated TV procedures and 56 were concomitant with mitral surgery. The mean patient age was 67 ± 14.4 years, 57% were female, and 11 patients (16%) had previous heart surgery. TVr with an annuloplasty band occurred in 97% of patients, 1 patient had a tissue valve replacement, and there were no conversions to sternotomy. Early mortality occurred in 1 patient (1.4%) with an observed to expected ratio of 0.4. Early postoperative echocardiography revealed none to mild residual tricuspid regurgitation (TR) in 65 patients (93%). Clinical follow-up was completed in 97% of patients. All-cause mortality occurred in 14 patients (20%), 11 of which were noncardiac, including cancer, gastrointestinal bleed, end-stage renal disease, SARS-CoV-2 infection, and drug overdose. Follow-up echocardiography results were available for 46 patients (66%) at a mean of 45 months, showing moderate or more recurrent TR in 6 patients (9%).

Conclusions: Robot-assisted totally endoscopic TV surgery, for both isolated and concomitant TV disease, is a safe and effective approach. The sternal-sparing nature allows for rapid recovery and positive midterm outcomes.