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Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

2023Journal article Open access
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dc.contributor.authorManolache, V
dc.contributor.authorMotas, N
dc.contributor.authorBosinceanu, ML
dc.contributor.authorde la Torre, M
dc.contributor.authorGallego-Poveda, J
dc.contributor.authorDunning, J
dc.contributor.authorIsmail, M
dc.contributor.authorTurna, A
dc.contributor.authorParadela, M
dc.contributor.authorDecker, G
dc.contributor.authorRamos, R
dc.contributor.authorBodner, J
dc.contributor.authorJimenez, DE
dc.contributor.authorZardo, P
dc.contributor.authorGarcia-Perez, A
dc.contributor.authorUreña Lluveras, A
dc.contributor.authorPantile, D
dc.contributor.authorGonzalez-Rivas, D
dc.date.accessioned2023-04-16T21:03:38Z
dc.date.available2023-04-16T21:03:38Z
dc.date.issued2023
dc.description.abstractBackground: Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods: We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results: Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions: U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAnn Cardiothorac Surg . 2023 Mar 31;12(2):102-109.pt_PT
dc.identifier.doi10.21037/acs-2022-urats-27pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/44547
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectNeoplasias do Pulmãopt_PT
dc.subjectProcedimentos Cirúrgicos Robóticospt_PT
dc.subjectLung Neoplasmspt_PT
dc.subjectRobotic Surgical Procedurespt_PT
dc.titleComparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experiencept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage109pt_PT
oaire.citation.issue2pt_PT
oaire.citation.startPage102pt_PT
oaire.citation.titleAnnals of Cardiothoracic Surgerypt_PT
oaire.citation.volume12pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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