Abstrakt Hrudní chirurgie Březen 2011

“Quality of life after anterior mediastinal mass resection: A prospective study comparing open with robotic-assisted thoracoscopic resection.”

Balduyck, B., J. M. Hendriks, et al. (2011).

European Journal of Cardio-Thoracic Surgery 39(4): 543-548.


Objective: To prospectively evaluate quality of life (QoL) evolution after robotic-assisted thoracoscopic or open anterior mediastinal tumour resection with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module, LC-13. Methods: From January 2004 to December 2008, QoL was prospectively recorded in all patients undergoing surgery for mediastinal tumours. A total of 14 patients underwent thoracoscopic resection using the da Vinci robotic system (Intuitive Surgical, Inc., Mountain View, CA, USA), and 22 patients open resection through sternotomy. Questionnaires were administered before surgery and 1, 3, 6 and 12 months, postoperatively, with response rates of 100%, 86.1%, 94.4%; 75.0% and 86.1%, respectively. Results: Both approaches had comparable preoperative patients’ characteristics and QoL subscales. Open resection by sternotomy was characterised by a significant decrease in general functioning 1 month after surgery (physical functioning p= 0.001, role functioning p= 0.001, and social functioning p= 0.044). Patients also complained of increased thoracic pain in the first 3 months after surgery (p= 0.017). After a da Vinci robotic resection QoL scores approximated baseline preoperative values 1 month after surgery, with the exception of increase in thoracic and shoulder pain the first 3 months after surgery (p= 0.028 and 0.029, respectively). Conclusions: Numerous techniques have been published with different degrees of invasiveness, generating the existing controversy as to which is the best surgical approach for anterior mediastinal tumours. The high burden of decreased physical functioning reported after sternotomy is not seen after a da Vinci robotic-assisted thoracoscopic resection. The initial experience and postoperative QoL data are excellent and, therefore, the da Vinci robot will stay our future technique of choice for the treatment of resectable mediastinal tumours smaller than 4. cm on imaging techniques. © 2010 European Association for Cardio-Thoracic Surgery.




“Robot-assisted resection of pulmonary sequestrations.”

Melfi, F. M. A., A. Viti, et al. (2011).

European Journal of Cardio-Thoracic Surgery.


Pulmonary sequestration is a rare congenital malformation and may cause recurrent infections and hemoptysis. Although video-assisted thoracic surgery (VATS) is feasible, some drawbacks remain, mainly dealing the managing of anomalous vessels. We describe the use of a robotic system (da Vinci Robotic System, Surgical Intuitive, Mountain View, CA, USA) in the treatment of four consecutive cases of pulmonary sequestration. © 2011 European Association for Cardio-Thoracic Surgery.




“Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study.”

Rückert, J. C., M. Swierzy, et al. (2011).

Journal of Thoracic and Cardiovascular Surgery 141(3): 673-677.


Objective: Radical thymectomy has become more popular in the comprehensive treatment of myasthenia gravis. Minimally invasive techniques are increasingly used for thymectomy. The most recent development in robotic thoracoscopic surgery has been successfully applied for mediastinal pathologies. To establish robotic technique as a standard, the results of high-volume centers and comparison with traditional surgery are mandatory. Methods: In a retrospective cohort study, the results of 79 thoracoscopic thymectomies (October 1994 to December 2002) were compared with the results of 74 robotic thoracoscopic thymectomies (January 2003 to August 2006). Data from both series were collected prospectively. In both groups, all patients had myasthenia gravis. Both cohorts were compared with respect to severity of disease, gender, age, histology, and postoperative morbidity. All patients were analyzed for quantification of improvement of disease according to the Myasthenia Gravis Foundation of America. Results: There were no differences in age distribution and severity of myasthenia gravis. The dominant histologic finding was follicular hyperplasia of the thymus in both groups with a significantly higher percentage in the thoracoscopic thymectomy series (68% vs 45%, P < .001). After a follow-up of 42 months, the cumulative complete remission rate of myasthenia gravis for robotic and nonrobotic thymectomy was 39.25% and 20.3% (P = .01), respectively. Conclusions: There is an improved outcome for myasthenia gravis after robotic thoracoscopic thymectomy compared with thoracoscopic thymectomy. Copyright © 2011 by The American Association for Thoracic Surgery.




“Pneumonectomy for lung cancer: A further step in minimally invasive surgery.”

Spaggiari, L. and D. Galetta (2011).

Annals of Thoracic Surgery 91(3): e45-e47.


Robotic lobectomies have been proven to be technically and oncologically feasible. To date, however, pneumonectomy is still considered as a too extensive resection to be performed by the da Vinci robotic system (Intuitive Surgical, Mountain View, CA). We describe 2 patients with centrally located non-small cell lung cancer requiring pneumonectomy and radical lymph node dissection. The operations, consisting of a left and a right pneumonectomy, were successfully performed by a totally video-assisted robotic approach. Tips and pitfalls in this latest innovation in the minimally invasive surgery for lung cancer are discussed. © 2011 The Society of Thoracic Surgeons.