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Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases

Since the first uniportal video-assisted thoracoscopic surgery (uVATS) performed in 2010, the uniportal approach has evolved up to a point where even the most complex cases can be done. This is thanks to the experience acquired over the years, the specifically designed instruments and improvements i...

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Autores principales: Gonzalez-Rivas, Diego, Bosinceanu, Mugurel, Manolache, Veronica, Gallego-Poveda, Javier, Paradela, Marina, Li, Shuben, Garcia, Alejandro, Bale, Manjunath, Motas, Natalia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922765/
https://www.ncbi.nlm.nih.gov/pubmed/36793981
http://dx.doi.org/10.21037/acs-2022-urats-23
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author Gonzalez-Rivas, Diego
Bosinceanu, Mugurel
Manolache, Veronica
Gallego-Poveda, Javier
Paradela, Marina
Li, Shuben
Garcia, Alejandro
Bale, Manjunath
Motas, Natalia
author_facet Gonzalez-Rivas, Diego
Bosinceanu, Mugurel
Manolache, Veronica
Gallego-Poveda, Javier
Paradela, Marina
Li, Shuben
Garcia, Alejandro
Bale, Manjunath
Motas, Natalia
author_sort Gonzalez-Rivas, Diego
collection PubMed
description Since the first uniportal video-assisted thoracoscopic surgery (uVATS) performed in 2010, the uniportal approach has evolved up to a point where even the most complex cases can be done. This is thanks to the experience acquired over the years, the specifically designed instruments and improvements in imaging. However, in these last few years, robotic-assisted thoracoscopic surgery (RATS) has also shown progress and distinct advantages compared to the uniportal VATS approach, thanks to advanced maneuverability of the robotic arms as well as the three-dimensional (3D) view. Excellent surgical outcomes have been reported and so too, the ergonomic benefits to the surgeon. The main limitation we find of the robotic systems is that they are designed for a multiport approach, requiring between three to five incisions to be able to perform surgeries. With the aim to offer the least invasive approach, using the robotic technology we decided to adapt the Da Vinci Xi(®) in September 2021 to develop the uniportal pure RATS approach (uRATS) performed by a single intercostal incision, without rib spreading and using the robotic staplers. We have now reached a point where we perform all type of procedures, including the more complex sleeve resections. Sleeve lobectomy is now widely accepted as a reliable and safe procedure to allow complete resection of centrally located tumors. Although it is a technically challenging surgical technique, it offers better outcomes when compared to pneumonectomy. The intrinsic characteristics of the robot such as the 3D view and improved maneuverability of instruments make the sleeve resections easier compared to thoracoscopic techniques. As in uVATS vs. multiport VATS, the uRATS approach, due to its geometrical characteristics, requires specific instrumentation, different movements and learning curve compared to multiport RATS. In this article we describe the surgical technique and our initial uniportal pure RATS experience with bronchial, vascular sleeves and carinal resections in 30 patients.
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spelling pubmed-99227652023-02-14 Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases Gonzalez-Rivas, Diego Bosinceanu, Mugurel Manolache, Veronica Gallego-Poveda, Javier Paradela, Marina Li, Shuben Garcia, Alejandro Bale, Manjunath Motas, Natalia Ann Cardiothorac Surg Keynote Lecture Series Since the first uniportal video-assisted thoracoscopic surgery (uVATS) performed in 2010, the uniportal approach has evolved up to a point where even the most complex cases can be done. This is thanks to the experience acquired over the years, the specifically designed instruments and improvements in imaging. However, in these last few years, robotic-assisted thoracoscopic surgery (RATS) has also shown progress and distinct advantages compared to the uniportal VATS approach, thanks to advanced maneuverability of the robotic arms as well as the three-dimensional (3D) view. Excellent surgical outcomes have been reported and so too, the ergonomic benefits to the surgeon. The main limitation we find of the robotic systems is that they are designed for a multiport approach, requiring between three to five incisions to be able to perform surgeries. With the aim to offer the least invasive approach, using the robotic technology we decided to adapt the Da Vinci Xi(®) in September 2021 to develop the uniportal pure RATS approach (uRATS) performed by a single intercostal incision, without rib spreading and using the robotic staplers. We have now reached a point where we perform all type of procedures, including the more complex sleeve resections. Sleeve lobectomy is now widely accepted as a reliable and safe procedure to allow complete resection of centrally located tumors. Although it is a technically challenging surgical technique, it offers better outcomes when compared to pneumonectomy. The intrinsic characteristics of the robot such as the 3D view and improved maneuverability of instruments make the sleeve resections easier compared to thoracoscopic techniques. As in uVATS vs. multiport VATS, the uRATS approach, due to its geometrical characteristics, requires specific instrumentation, different movements and learning curve compared to multiport RATS. In this article we describe the surgical technique and our initial uniportal pure RATS experience with bronchial, vascular sleeves and carinal resections in 30 patients. AME Publishing Company 2023-01-06 2023-01-31 /pmc/articles/PMC9922765/ /pubmed/36793981 http://dx.doi.org/10.21037/acs-2022-urats-23 Text en 2023 Annals of Cardiothoracic Surgery. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Keynote Lecture Series
Gonzalez-Rivas, Diego
Bosinceanu, Mugurel
Manolache, Veronica
Gallego-Poveda, Javier
Paradela, Marina
Li, Shuben
Garcia, Alejandro
Bale, Manjunath
Motas, Natalia
Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title_full Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title_fullStr Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title_full_unstemmed Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title_short Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
title_sort uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases
topic Keynote Lecture Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922765/
https://www.ncbi.nlm.nih.gov/pubmed/36793981
http://dx.doi.org/10.21037/acs-2022-urats-23
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