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ROBOTIC LOBECTOMY: FIRST CASE

ROBOTIC LOBECTOMY: FIRST CASE. Tuğba Coşgun *, Oral Akın*, Haluk Akpınar**, Cemal Asım Kutlu* * Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 3. Thoracic Surgery Clinic ** Bilim University, Urology Clinic. OBJECTİVE.

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ROBOTIC LOBECTOMY: FIRST CASE

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  1. ROBOTIC LOBECTOMY:FIRST CASE Tuğba Coşgun*, Oral Akın*, Haluk Akpınar**, Cemal Asım Kutlu* * Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 3. Thoracic Surgery Clinic ** Bilim University, Urology Clinic

  2. OBJECTİVE • To show the applicability of robotic surgery system in thoracic surgery

  3. Robot:Forced Labor (Karel Capek,1921) • History: • 1993: developed by AESOP (voice controlled camera holder) • 1994: marketed by US FDA. • Endoassist’(Armstrong Healthcare Ltd., High Wycombe, Buck, UK), • FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany) developed to add to the functions of the robot and try and increase its utility • Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System((R)) classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist((R)). • FDA certify: • July 2000 General Laparoscopic Surgery • November 2002 Mitral Valv Repair Surgery

  4. METHODS • Turkey → 2005 • Urology, General Surgery, Gynecology, CVS • In a lot of centre robotic surgery has performed in thoracic surgery. Operation indications are various as resection to sympathectomy.

  5. CASE • 29/F • Hemopthysis • CT→ Bronchiectasis, left lower lob

  6. OPERATION • Left forth intercostal : • ‘utility’ incision • Mid-axillary line, diaphragmatic border: • Second • Posterior-axillary line: • Third thoracar incision. • Between second and third incision: • Forth incision (Traction)

  7. RESULTS • Transfusion • 1U ES • Post-operative ICU • Extubated • Drainage • Two days/ 300cc • Discharged • Post-operative third day

  8. VATS Lobectomy Since 2003

  9. Urology, General surgery, CVS, Thoracic surgery, Pediatric surgery • Advantages: • 3D vision, • Motion capability, • Tremor filtration • Magnify the vision 10-12 times. • The instruments can rotate itself 540 degrees (endowrist)

  10. Minimaly invasive, • Esthetic, • Less dehidratation, • Complication rate and the number of dissected lymph nodules are not significant. • Hospitalization, postoperative pain and peroperative bleeding are significantly lower. • 2009 Dec 26.Four arm robotic lobectomy for the threatment of early stage lung cancer. Veronesi G,Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.

  11. Less bleeding, Easier pnömolizis, Less convertions to open surgery. 2009 Jun.Robot assisted thorcoskopik surgery of interlobr sequestration. Al-Mufarrej F. Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC

  12. Comparingrobotic VATS lobectomy,VATS lobectomyandthoracotomywithcosts; thebiggestwascalculatedthoracotomyandthesmallestwasVATS lobectomy. • Hospitalization • 2008 Aug. Costcomparison of robotic, video-assistedthoracicsurgeryandthoracotomyapproachestopulmonarylobectomy. Park BJDepartment of Surgery, MemorialSloan-KetteringCancerCenter, 1275 York Avenue, New York.

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