Ricardo Mingarini Terra1,2,3,4,5, Rui Haddad6,7,8, José Ribas Milanese de Campos9,10, Pedro Henrique Xavier Nabuco de Araújo11,10,12,13, Carlos Eduardo Teixeira Lima7,8, Felipe Braga7,8, Benoit Jacques Bibas11,10, Juliana Mol Trindade11,12, Leticia Leone Lauricella11,10,12,13, Paulo Manuel Pêgo-Fernandes9,11,10,12. 1. Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-000, Brazil. rmterra@uol.com.br. 2. Instituto do Câncer do Estado de São Paulo, 251, Dr. Arnaldo Ave. Cerqueira César, São Paulo, SP, 01246-000, Brazil. rmterra@uol.com.br. 3. Hospital Israelita Albert Einstein, 627, Albert Einstein Ave., Jardim Leonor, São Paulo, SP, 05652-900, Brazil. rmterra@uol.com.br. 4. Hospital Sírio e Libanês, 115, Dona Adma Jafet St., Bela Vista, São Paulo, SP, 01308-050, Brazil. rmterra@uol.com.br. 5. Hospital São Luiz Itaim, 95, Dr. Alceu de Campos Rodrigues St., Vila Nova Conceição, São Paulo, SP, 04544-000, Brazil. rmterra@uol.com.br. 6. Escola Médica de Pós-Graduação, Pontifícia Universidade Católica do Rio de Janeiro, 36, Estrada da Gávea, Gávea, Rio de Janeiro, RJ, 22451-262, Brazil. 7. Hospital Copa Star, 700, Figueiredo de Magalhães St., Copacabana, Rio de Janeiro, RJ, 22031-012, Brazil. 8. Hospital Quinta D'Or, 435, Alm. Baltazar, São Cristóvão, Rio de Janeiro, RJ, 20941-150, Brazil. 9. Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, 44, Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-000, Brazil. 10. Hospital Israelita Albert Einstein, 627, Albert Einstein Ave., Jardim Leonor, São Paulo, SP, 05652-900, Brazil. 11. Instituto do Câncer do Estado de São Paulo, 251, Dr. Arnaldo Ave. Cerqueira César, São Paulo, SP, 01246-000, Brazil. 12. Hospital Sírio e Libanês, 115, Dona Adma Jafet St., Bela Vista, São Paulo, SP, 01308-050, Brazil. 13. Hospital São Luiz Itaim, 95, Dr. Alceu de Campos Rodrigues St., Vila Nova Conceição, São Paulo, SP, 04544-000, Brazil.
Abstract
BACKGROUND: In the last decade, robotic video-assisted thoracic surgery (R-VATS) has grown significantly and consolidated as an alternative to video-assisted thoracic surgery. The objective of this study is to present the implementation as well as the experience with R-VATS accumulated by 2 Brazilian groups. We also compared the outcomes of procedures performed during the learning curve and after a more mature experience. METHODS: Retrospective cohort study included all R-VATS procedures performed since April 2015 until April 2018. We describe the process of implantation of robotic surgery, highlighting the peculiarities and difficulties found in a developing country. Moreover, we reported our descriptive results and compared the first 60 patients to the subsequent cases. RESULTS: Two hundred and five patients included 101 females/104 males. Mean age was 61.7 years. There were hundred and sixty-four pulmonary resections, 39 resections of mediastinal lesions, 1 diaphragmatic plication, and 1 resection of a hilar tumor. Median operative times were 205 min for lung resections and 129 min for mediastinal. There was no conversion to VATS or thoracotomy or major intraoperative complications. Median length of stay was 3 days for pulmonary resections and 1 day for mediastinal. Postoperative complications occurred in 35 cases (17.0%)-prolonged air leak was the most common (17 cases). One fatality occurred in an elderly patient with pneumonia and sepsis (0.4%). Comparison of the first 60 patients (learning curve) with subsequent 145 patients (consolidated experience) showed significant differences in surgical and ICU time, both favoring consolidated experience. CONCLUSIONS: Our results were comparable to the literature. Robotic thoracic surgery can be safely and successfully implemented in tertiary hospitals in emerging countries provided that all stakeholders are involved and compromised with the implementation process.
BACKGROUND: In the last decade, robotic video-assisted thoracic surgery (R-VATS) has grown significantly and consolidated as an alternative to video-assisted thoracic surgery. The objective of this study is to present the implementation as well as the experience with R-VATS accumulated by 2 Brazilian groups. We also compared the outcomes of procedures performed during the learning curve and after a more mature experience. METHODS: Retrospective cohort study included all R-VATS procedures performed since April 2015 until April 2018. We describe the process of implantation of robotic surgery, highlighting the peculiarities and difficulties found in a developing country. Moreover, we reported our descriptive results and compared the first 60 patients to the subsequent cases. RESULTS: Two hundred and five patients included 101 females/104 males. Mean age was 61.7 years. There were hundred and sixty-four pulmonary resections, 39 resections of mediastinal lesions, 1 diaphragmatic plication, and 1 resection of a hilar tumor. Median operative times were 205 min for lung resections and 129 min for mediastinal. There was no conversion to VATS or thoracotomy or major intraoperative complications. Median length of stay was 3 days for pulmonary resections and 1 day for mediastinal. Postoperative complications occurred in 35 cases (17.0%)-prolonged air leak was the most common (17 cases). One fatality occurred in an elderly patient with pneumonia and sepsis (0.4%). Comparison of the first 60 patients (learning curve) with subsequent 145 patients (consolidated experience) showed significant differences in surgical and ICU time, both favoring consolidated experience. CONCLUSIONS: Our results were comparable to the literature. Robotic thoracic surgery can be safely and successfully implemented in tertiary hospitals in emerging countries provided that all stakeholders are involved and compromised with the implementation process.
Authors: Brian E Louie; Jennifer L Wilson; Sunghee Kim; Robert J Cerfolio; Bernard J Park; Alexander S Farivar; Eric Vallières; Ralph W Aye; William R Burfeind; Mark I Block Journal: Ann Thorac Surg Date: 2016-05-19 Impact factor: 4.330
Authors: Ricardo Mingarini Terra; Thamara Kazantzis; Darcy Ribeiro Pinto-Filho; Spencer Marcantonio Camargo; Francisco Martins-Neto; Anderson Nassar Guimarães; Carlos Alberto Araújo; Luis Carlos Losso; Mario Claudio Ghefter; Nuno Ferreira de Lima; Antero Gomes-Neto; Flávio Brito-Filho; Rui Haddad; Maurício Guidi Saueressig; Alexandre Marcelo Rodrigues Lima; Rafael Pontes de Siqueira; Astunaldo Júnior de Macedo E Pinho; Fernando Vannucci Journal: J Bras Pneumol Date: 2016 May-Jun Impact factor: 2.624
Authors: Ricardo Mingarini Terra; Pedro Henrique Xavier Nabuco de Araujo; Leticia Leone Lauricella; José Ribas Milanez de Campos; Herbert Felix Costa; Paulo Manuel Pego-Fernandes Journal: J Bras Pneumol Date: 2016 May-Jun Impact factor: 2.624