Abstrakt Hrudní chirurgie Únor 2012

Gulkarov, I., D. Ciaburri, et al. (2012). “Robotic thoracoscopic resection of intralobar sequestration.” Journal of Robotic Surgery: 1-3.

In this manuscript we report a case of fully robotic thoracoscopic resection of intralobar pulmonary sequestration. The Da Vinci robot provides surgeons with great three-dimensional visualization and enhanced dexterity. This enables a safer, more precise dissection of sequestered pulmonary tissue. Robotic technology may result in fewer complications and less conversions to open surgery in cases of pulmonary sequestration. © 2012 Springer-Verlag London Ltd.


Ishikawa, N., M. Kawaguchi, et al. (2012). “Robot-Assisted Resection of Multiple Schwannomas of the Neck and Mediastinum Through an Axillary Approach.” Artificial Organs.

A 49-year-old woman was referred to our department for increased schwannoma of the right neck and mediastinum. We chose a robot-assisted endoscopic approach to minimize the operative trauma. After exposure of the thyroid through the right axilla, the neck tumor was resected using the da Vinci Surgical System. A mini-thoracotomy was then made in the left third intercostal space through the axillary incision, robotic instruments were introduced across the thoracic cavity, and the tumor was excised circumferentially using the robot. Histopathological examination of both specimens revealed schwannomas. This procedure has benefited the patient with good cosmetic results and allowed her to rapidly resume her daily activities.


Melfi, F., O. Fanucchi, et al. (2012). “Ten-year experience of mediastinal robotic surgery in a single referral centre.” European Journal of Cardio-Thoracic Surgery.

OBJECTIVEThe aim of this study was to report a single referral centre experience in the exeresis of mediastinal lesions with robotic surgical system. The outcomes of all patients were retrospectively investigated with special regard to myasthenic and thymomatous patients.METHODSFrom February 2001 to December 2010, 69 patients (30 males, 39 females), with a mean age of 55.4 years (range 20-81), underwent robotic surgery for treatment of mediastinal lesions. There were 39 thymectomies, 13 paravertebral neurogenic tumour removals, 9 pleuropericardial cyst removals, 3 teratoma excisions, 4 lymphonodal removals and 1 enterogenous cyst excision. Operative time, conversion rate, morbidity and mortality were analysed.RESULTSThere were no intra-operative complications, and no mortality. The mean operative time was 124.3 min (range 45-240). Conversion to open surgery occurred in three cases (4.3%). All post-operative complications (7.2%) were conservatively treated. The mean post-operative stay was 4.3 days (range 3-10). For the myasthenic patients (mean follow-up of 18 months), the Myasthenia Gravis Foundation of America change in status resulted improved in 18 (90%) patients and unchanged in 2 (10%) patients. In cases of thymoma, the pathological analysis revealed Masaoka stage I (seven cases), IIA (three cases), IIB (two cases) and III (one case). No disease recurrence occurred at a mean follow-up of 16 months.CONCLUSIONSOur experience suggests that the surgical system was safe in performing mediastinal mass resection, with low morbidity and conversion rate. The robotic system proved useful, especially in a tiny space such as the mediastinum, and appeared to be an effective treatment for myasthenia gravis and for early-stage thymoma.


Melfi, F. M., A. Viti, et al. (2011). “Robot-assisted resection of pulmonary sequestrations.” European Journal of Cardio-Thoracic Surgery 40(4): 1025-1026.

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.


Park, B. J., F. Melfi, et al. (2012). “Robotic lobectomy for non-small cell lung cancer (NSCLC): Long-term oncologic results.” Journal of Thoracic and Cardiovascular Surgery 143(2): 383-389.

Objective(s): We evaluated a large series of patients undergoing robotic lobectomy for the treatment of early-stage non-small cell lung cancer (NSCLC) to assess long-term oncologic efficacy. Methods: A multi-institutional retrospective review of patients undergoing robotic lobectomy for NSCLC was performed. Robotic lobectomy was performed in a manner consistent with the Cancer and Leukemia Group B (CALGB) consensus video-assisted thoracic surgery (VATS) lobectomy technique using a robotic surgical system. Perioperative outcomes and long-term follow-up were recorded prospectively, and survival was calculated from the date of surgery to last follow-up. Results: From November 2002 through May 2010, a total of 325 consecutive patients underwent robotic lobectomy for early-stage NSCLC at 3 institutions. The median age of patients was 66 years (range, 30-87 years), and 37% (120) were female. The majority were in clinical stage I (IA, 247; IB, 63). Conversion rate to thoracotomy was 8% (27/325). Overall morbidity rate was 25.2% (82/325), and major complication rate was 3.7% (12/325). There was 1 in-hospital death (0.3%), and the median length of stay was 5 days (range, 2-28 days). Pathologic stage distribution was 54% (176) IA, 22% (72) IB, 13% (41) IIA, 5% (15) IIB, and 6% (21) IIIA. With a median follow-up of 27 months, overall 5-year survival was 80% (95% confidence intervals [CI] = 73-88), and by pathologic stage, 91% (CI = 83-99) for stage IA, 88% (CI = 77-98) for stage IB, and 49% (CI = 24-74) for all patients with stage II disease. Overall 3-year survival for patients with stage IIIA disease was 43% (CI = 16-69). Conclusions: Robotic lobectomy for early-stage NSCLC can be performed with low morbidity and mortality. Long-term stage-specific survival is acceptable and consistent with prior results for VATS and thoracotomy. © 2012 by The American Association for Thoracic Surgery.