Abstrakt Hrudní chirurgie Březen 2009

“Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy.”

Choi, Y. S., J. K. Shim, et al. (2009).

Surgical Endoscopy: 1-6.


Background: The prone position during robotic esophageal mobilization for minimally invasive esophagectomy (MIE) provides several advantages with regards to operative times, surgeon ergonomics, and surgical view; however, this technique requires one-lung ventilation (OLV). There are no guidelines about ventilatory modes during OLV in the prone position. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on oxygenation and intrapulmonary shunt during OLV in the prone position in patients who underwent robot-assisted esophagectomy. Methods: Eighteen patients, no major obstructive or restrictive pulmonary disease, were allocated randomly to one of two groups. In the first group (n = 9), OLV was started by VCV and the ventilator was switched to PCV after 30 minutes. In the second group (n = 9), the modes of ventilation were performed in the opposite order in the prone position. Hemodynamic and respiratory variables were obtained during OLV at the end of each ventilatory mode. Results: There were no significant differences in arterial oxygen tension (PaO2), airway pressures, dynamic lung compliance, or physiologic dead space (Vd/Vt) during OLV between PCV and VCV in the prone position. Intrapulmonary shunt (Qs/Qt) was significantly lower with VCV than with PCV during OLV in the prone position (p = 0.044). Conclusion: PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robot-assisted esophagectomy and who have normal body mass index and preserved pulmonary function. © 2009 Springer Science+Business Media, LLC.


“Robotic versus human camera holding in video-assisted thoracic sympathectomy: A single blind randomized trial of efficacy and safety.”

Rua, J. F. M., F. B. Jatene, et al. (2009).

Interactive Cardiovascular and Thoracic Surgery 8(2): 195-199.

Our objective is to compare surgical safety and efficacy between robotic and human camera control in video-assisted thoracic sympathectomy. A randomized-controlled-trial was performed. Surgical operation was VATS sympathectomy for hyperhidrosis. The trial compared a voice-controlled robot for holding the endoscopic camera robotic group (Ro) to human assisted group (Hu). Each group included 19 patients. Sympathectomy was achieved by electrodessication of the third ganglion. Operations were filmed and images stored. Two observers quantified the number of involuntary and inappropriate movements and how many times the camera was cleaned. Safety criteria were surgical accidents, pain and aesthetical results; efficacy criteria were: surgical and camera use duration, anhydrosis, length of hospitalization, compensatory hyperhidrosis and patient satisfaction. There was no difference between groups regarding surgical accidents, number of involuntary movements, pain, aesthetical results, general satisfaction, number of lens cleaning, anhydrosis, length of hospitalization, and compensatory hyperhidrosis. The number of contacts of the laparoscopic lens with mediastinal structures was lower in the Ro group (P<0.001), but the total and surgical length was longer in this group (P<0.001). Camera holding by a robotic arm in VATS sympathectomy for hyperhidrosis is as safe but less efficient when compared to a human camera-holding assistant. © 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.