Robot - assisted thoracic surgery using conventional thoracoscopic surgery access

Abstract

Abstract Introduction: Video-assisted thoracic surgery (VATS) has been widely used and confirmed to be effective and less invasive compared to traditional open surgery. Robotic-assisted thoracic surgery (RATS ) is actually a VATS using a robot controlled by human surgeon. RATS has been applied worldwide, however still less in Vietnam. We have been starting RATS since July 2018, using conventional thoracoscopic access (trocars). Aim of our paper is to report our initial results after 18 months implementing. Material and Methods: Retrospectively review 116 cases of RATS from July 2018 to January 2020. Trocar were placed according to type of operations: for lobectomy and pathologies of posterior and middle at lateral position with 4 ports, for thymectomy without tumor or with small tumor at lateral position at a 45 degree angle with 4 ports at one chest side or bilateral at subxiphoid approach with 4 ports. Trocars placed follow the endoscopic triangle principle similar to those for VATS Results: Among of 116 cases were : 57 cases of lobectomy, 9 cases of wedge resection, thymectomy - 19 cases, mediastinal tumor resection - 28 cases, esophagectomy - 1 case, esophageal leiomyoma resection - 1 case, and diaphragmatic plication - 1 case. Good outcomes are 110 cases, no complications, 5 cases with prolong air leak requiring chest tube for over 5 days. One death after 35 days due to pneumonia. The surgery time is similar to VATS. Average chest tube removal was 2 days. Post-operative length stay was equivalent to VATS. Conclusion: RATS is safe with good results in our series. The transition process from VATS to RATS is safe in the medical facilities with surgeons who have good background in VATS. The conventional trocar placement is suitable for RATSs application. Keywords: VATS, RATS