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Robot-Assisted Bronchoscopy for Identification of Lung Nodules During Minimally Invasive Pulmonary Resection. 机器人辅助支气管镜在微创肺切除术中识别肺结节
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241247549
James Shahoud, Benny Weksler, Sohini Ghosh, Aarthi Ganesh, Hiran Fernando

Objective: Small pulmonary nodules can be difficult to identify during minimally invasive surgical (MIS) resection. Previous investigators have reported using standard bronchoscopy with electromagnetic navigation to identify small pulmonary nodules. Robot-assisted bronchoscopy has been introduced into clinical practice and has shown utility for the biopsy of small lesions. We report our experience using robot-assisted bronchoscopy with dye marking to aid in minimally invasive pulmonary resection.

Methods: Patients with peripheral pulmonary nodules underwent robot-assisted bronchoscopy before a planned minimally invasive resection. Indocyanine green or methylene blue was injected directly into the targeted lesion. Surgical resection was then immediately performed. Success was defined as dye visualization leading to sublobar resection of the target nodule without the need for lobectomy or thoracotomy.

Results: Thirty patients with a single targeted nodule underwent robot-assisted bronchoscopy followed by MIS resection. The median lesion size was 9 mm (4 to 25 mm), and the median distance from the pleura was 5 mm (1 to 32 mm). The success rate was 83.3% (25 of 30). There were 3 cases in which the dye was not visualized, and in 2 cases there was free extravasation of dye. The targeted nodule was identified in these 5 patients without the need for thoracotomy or lobectomy. Pathology revealed non-small cell lung cancer (n = 13, 43.3%), metastatic disease (n = 11, 36.7%), and benign disease (n = 6, 20%). There were no complications related to the use of robot-assisted bronchoscopy.

Conclusions: Robot-assisted bronchoscopy with dye marking is safe and effective for guiding minimally invasive resection of small peripheral pulmonary nodules.

目的:微创手术(MIS)切除时很难识别肺部小结节。以前的研究者曾报告过使用标准支气管镜和电磁导航来识别肺部小结节。机器人辅助支气管镜已被引入临床实践,并显示出其在小病灶活检方面的实用性。我们报告了使用带有染料标记的机器人辅助支气管镜辅助微创肺切除术的经验:方法:外周肺结节患者在计划的微创切除术前接受机器人辅助支气管镜检查。将吲哚菁绿或亚甲蓝直接注入目标病灶。然后立即进行手术切除。成功的定义是染料可视化导致肺叶下靶结节切除,而无需进行肺叶切除或开胸手术:30名单个目标结节患者接受了机器人辅助支气管镜检查和MIS切除术。病灶的中位尺寸为 9 毫米(4 至 25 毫米),与胸膜的中位距离为 5 毫米(1 至 32 毫米)。成功率为 83.3%(30 例中有 25 例)。有 3 例未观察到染料,2 例染料自由外渗。在这 5 例患者中,无需进行开胸手术或肺叶切除术即可确定目标结节。病理结果显示为非小细胞肺癌(13 例,占 43.3%)、转移性疾病(11 例,占 36.7%)和良性疾病(6 例,占 20%)。使用机器人辅助支气管镜检查未出现并发症:带染料标记的机器人辅助支气管镜可安全有效地引导微创切除周围肺部小结节。
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引用次数: 0
Robotic Thoracic Duct Repair Using Indocyanine Green Guidance. 使用吲哚菁绿引导的机器人胸导管修复术
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241246565
Oscar Zhang, Joanne Irons, Jaime Santibanez, Christopher Cao
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引用次数: 0
Low-Cost Innovations in Global Cardiac Surgery. 全球心脏外科的低成本创新。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-06-03 DOI: 10.1177/15569845241252441
Hera Jamil, Sruthi Ranganathan, Aemon B Fissha, Eric E Vinck, Dominique Vervoort

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.

心血管疾病是全球发病率和死亡率的主要原因,每年导致 1800 万人丧生,其中高达三分之一的人死于心脏外科疾病。约有 60 亿人无法获得安全、及时和负担得起的心脏手术治疗,这主要影响到中低收入国家的人口。心脏外科护理成本高昂,因此在资源多变的环境中,很少有中心能够持续运营或拥有在资源较丰富环境中观察到的资源。因此,可能会正式开发或非正式采用创新技术,以绕过资源限制,确保提供护理服务。在心脏外科护理的各个环节和各种环境中都可以看到创新的身影,这些创新可能会惠及高收入国家和中低收入国家,前者日益增长的医疗费用已变得难以为继,而后者相互竞争的健康议程可能会限制对心脏外科的投资。这篇叙述性综述试图探讨心脏外科手术的相关成本,重点是围手术期和术后护理方面的节俭创新。
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引用次数: 0
Letter to the Editor: Facilitating Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting. 致编辑的信:促进微创冠状动脉旁路移植术的近端吻合。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241258486
Zeynep Sıla Özcan, Murat Baştopçu, Gökhan Arslanhan, Anıl Karaağaç, Şahin Şenay, Muharrem Koçyiğit, Aleks Değirmencioğlu, Deniz Alis, Cem Alhan
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引用次数: 0
The 7 Pillars of Transcatheter Tricuspid Valve Interventions. 经导管三尖瓣介入治疗的 7 大支柱。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241259498
Ali M Alakhtar, Tsuyoshi Kaneko
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引用次数: 0
Combined Cervicotomy and Robot-Assisted Surgical Approach for Intrathoracic Thyroid Goiter: A Case Series. 胸腔内甲状腺肿的联合颈椎切开术和机器人辅助手术方法:病例系列。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-10 DOI: 10.1177/15569845241247850
Giorgia Piccioni, Alessandra Siciliani, Fabiana Messa, Paolo Mercantini, Antonio D'Andrilli, Matteo Tiracorrendo, Erino Angelo Rendina, Mohsen Ibrahim
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引用次数: 0
Response to: Facilitating Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting. 回应:促进微创冠状动脉旁路移植术的近端吻合。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241258488
Hiroki Sakai, Keita Kikuchi
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引用次数: 0
The 10 Commandments for Endoscopic Minimally Invasive Tricuspid Valve Repair. 内窥镜微创三尖瓣修复十诫
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241264571
Mohsyn Imran Malik, Michael W A Chu
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引用次数: 0
Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass: Impact of Chest Wall Dimensions in Single and Multivessel Bypass. 机器人心跳-心脏全内镜冠状动脉搭桥术:单血管和多血管搭桥术中胸壁尺寸的影响。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-06-04 DOI: 10.1177/15569845241252170
Tatsuya Watanabe, Hiroto Kitahara, Sarah Nisivaco, Charocka Coleman, Brooke Patel, Husam H Balkhy

Objective: There can be anatomical constraints on patient selection for minimally invasive surgery. For example, robot-assisted coronary artery bypass was reported to be more challenging when patients had a cardiothoracic ratio >50% and a sternum-vertebra anteroposterior and transverse diameter ratio <0.45. We sought to examine the impact of chest wall anatomic parameters on surgical outcomes in our totally endoscopic coronary artery bypass (TECAB) procedures.

Methods: We retrospectively reviewed patients who underwent robotic TECAB, all of whom had a preoperative chest radiograph at our institution from July 2017 to October 2021. The cohort was divided into 2 groups, which were patients undergoing single-vessel grafting using the left internal thoracic artery (ITA; group 1) and patients undergoing multivessel grafting with bilateral ITA grafts (group 2). We measured several anatomical parameters from the preoperative chest radiograph.

Results: A total of 352 patients undergoing TECAB were retrospectively analyzed. After exclusions, 193 were included in this study. In group 1 (n = 91), no parameters correlated with operative time. In group 2 (n = 102), a significant negative correlation was observed between operative time and the sternum-vertebrae anteroposterior diameter (rs = -0.228, P = 0.022) and lung anteroposterior diameter (rs = -0.246, P = 0.013). To confirm these results in group 2, a propensity-matched analysis was performed and showed a statistically significant difference in surgical time based on chest anteroposterior diameters.

Conclusions: In single-vessel robotic TECAB, chest wall anatomic dimensions measured on chest radiograph did not affect operative time. In multivessel cases with bilateral ITA grafts, larger anteroposterior diameter correlated with shorter operative times.

目的:微创手术患者的选择可能会受到解剖结构的限制。例如,据报道,如果患者的心胸比例大于 50%,胸骨与椎体的前后径和横径之比大于 50%,那么机器人辅助冠状动脉搭桥术就更具挑战性:我们回顾性研究了2017年7月至2021年10月期间在我院接受机器人TECAB手术的患者,所有患者均有术前胸片。该组患者分为两组,即使用左胸内动脉(ITA)进行单血管移植的患者(第1组)和使用双侧ITA移植进行多血管移植的患者(第2组)。我们根据术前胸片测量了几个解剖参数:我们对 352 名接受 TECAB 手术的患者进行了回顾性分析。经排除后,193 例患者被纳入本研究。在第一组(91 人)中,没有参数与手术时间相关。在第2组(n = 102)中,观察到手术时间与胸骨-椎体前后径(rs = -0.228,P = 0.022)和肺脏前后径(rs = -0.246,P = 0.013)之间存在显著负相关。为了在第2组中证实这些结果,进行了倾向匹配分析,结果显示,根据胸部前胸直径,手术时间的差异具有统计学意义:在单血管机器人 TECAB 中,胸片上测量的胸壁解剖尺寸不会影响手术时间。在使用双侧ITA移植物的多血管病例中,前胸直径越大,手术时间越短。
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引用次数: 0
Single-Port Robotic Trans-Subxiphoid Surgery for Anterior Mediastinal Disease: A Pilot Trial. 单孔机器人经剑突下手术治疗前纵隔疾病:试点试验
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241248641
Chuan Cheng, Evangelos Tagkalos, Chong Beng Ng, Ya-Chun Hsu, Yu Ya Huang, Ching Feng Wu, Yin-Kai Chao

Objective: In recent years, there has been an increasing focus on minimally invasive mediastinal surgery using a trans-subxiphoid single-port thoracoscopic approach. Despite its potential advantages, the widespread adoption of this method has been hindered by the intricate surgical maneuvers required within the confined retrosternal space. Robotic surgery offers the potential to overcome the limitations inherent in the thoracoscopic technique.

Methods: This was a clinical trial (NCT05455840) to evaluate the feasibility and safety of utilizing the da Vinci® SP system (Intuitive Surgical, Sunnyvale, CA, USA) for trans-subxiphoid single-port surgery in patients with anterior mediastinal disease. The primary endpoints encompassed conversion rates and the secondary endpoints included the occurrence of perioperative complications.

Results: Between August 2022 and April 2023, a total of 15 patients (7 men and 8 women; median age = 56 years, interquartile range [IQR]: 49 to 65 years) underwent trans-subxiphoid robotic surgery using da Vinci SP platform for maximal thymectomy (n = 2) or removal of anterior mediastinal masses (n = 13). All surgical procedures were carried out with success, with no need for conversion to open surgery or the creation of additional ports. The median docking time was 2 min (IQR: 1 to 4 min), while the console time had a median of 152 min (IQR: 95 to 191 min). There were no postoperative complications and patients experienced a median postoperative hospital stay of 2 days with no unplanned 30-day readmission.

Conclusions: This study shows that trans-subxiphoid single-port robotic surgery employing the da Vinci SP system in patients with anterior mediastinal disease is clinically viable with acceptable safety and short-term outcomes.

目的:近年来,经剑突下单孔胸腔镜微创纵隔手术越来越受到关注。尽管这种方法具有潜在的优势,但由于需要在狭窄的胸骨后空间进行复杂的手术操作,因此阻碍了这种方法的广泛采用。机器人手术有可能克服胸腔镜技术固有的局限性:这是一项临床试验(NCT05455840),旨在评估在前纵隔疾病患者中使用达芬奇® SP 系统(Intuitive Surgical, Sunnyvale, CA, USA)进行经剑突下单孔手术的可行性和安全性。主要终点包括转换率,次要终点包括围手术期并发症的发生率:2022年8月至2023年4月期间,共有15名患者(7名男性,8名女性;中位年龄=56岁,四分位距[IQR]:49岁至65岁)接受了经胸手术:中位年龄=56岁,四分位数范围[IQR]:49至65岁)接受了经剑突下机器人手术,使用达芬奇SP平台进行最大胸腺切除术(2例)或前纵隔肿块切除术(13例)。所有手术均顺利进行,无需转为开放手术或创建额外的端口。对接时间的中位数为2分钟(IQR:1至4分钟),控制台时间的中位数为152分钟(IQR:95至191分钟)。术后无并发症,患者术后住院时间中位数为 2 天,30 天内无意外再入院:这项研究表明,在前纵隔疾病患者中使用达芬奇SP系统进行经剑突下单孔机器人手术在临床上是可行的,其安全性和短期疗效均可接受。
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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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