Written by: Dr Laura Staunton MCh MB BCh BAO, Ms Rebecca Weedle MCh FRCSI (CTh), Mr Ronan Ryan MD FRCSI (CTh), Mr Vincent Young MD FRCSI (CTh) & Mr Gerard J. Fitzmaurice MSc FRCSI (CTh), Department of Cardiothoracic Surgery, St James’s Hospital, Dublin
Respiratory - RATS
22
Robotic-Assisted Thoracic Surgery (RATS) is the pinnacle of modern thoracic surgical practice and was introduced at St James’s Hospital in July 2022. RATS enables a surgeon to perform Robotic-Assisted Thoracic Surgery – Early Results complex surgery on the chest using a console to control a number of robotic arms, offering advantages over traditional minimally invasive surgical techniques. At St James’s we offer a of an Expanding Program comprehensive minimally invasive thoracic surgical program with a minimally invasive Written by: Dr Laura Staunton MCh MB BCh BAO, Ms Rebecca Weedle MCh FRCSI (CTh), approach undertaken in up to 70% of our lung cancer operations. Mr Ronan Ryan MD FRCSI (CTh), Mr Vincent Young MD FRCSI (CTh) & Mr Gerard J. Fitzmaurice MSc FRCSI (CTh), Department of Cardiothoracic Surgery, St James’s Hospital, Dublin
Following a year of robotic thoracic surgical procedures, we have reviewed the early Robotic-Assisted Thoracic outcomes of ourSurgery expanding program combined withvisualisation our enhanced recovery Patient and complication rates (28-45%). improved due to complication protocol. rate in the first year (RATS) is the pinnacle of modern Patients also experience shorter a 3-dimensional camera that of our robotic program were very thoracic surgical practice and waslength of stay, chest drain duration, post-operative complications, as well outcomes including chest drain duration and reduced provides an enhanced view with low, with the main complication introduced at St James’s Hospital post-operative pain. highly magnified images. There of prolonged air leak (18%), in July 2022. RATS enables a as our robotic training program were examined. is a 6-Hz motion filter and motion consistent with other centres. surgeon to perform complex surgery on the chest using a console to control a number of robotic arms, offering advantages over traditional minimally invasive surgical techniques. At St James’s we offer a comprehensive minimally invasive thoracic surgical program with a minimally invasive approach undertaken in up to 70% of our lung cancer operations.
Over the course of the first year, we have performed 32 robotic-assisted thoracic surgical operations in a stepwise incremental approach. This enabled the safe introduction of a new surgical technique within the department with a focus on case selection and staff engagement. The operations performed included diagnostic lymph node dissection, thymectomies, sublobar resections, pleural-based chest wall tumour resections, and anatomical lobectomies. The median age of our patient cohort was 65 years with equal distribution of gender. Our results demonstrated a median chest drain duration of 1 day with a median post-operative length of stay of 2 days. Pain was well controlled with intercostal nerve blocks, patient control analgesia, and oral analgesia that included paracetamol and Ibuprofen with the occasional addition of opioids in select patients on discharge.
scaling system, which absorbs and filters physiological tremor, as well as offering dominant and non-dominant hand equivalence. The surgical movement is filtered by the robot, ensuring greater accuracy and precision. This ensures enhanced surgical dissection and suturing, with the resultant reduced surgical complications including blood loss. This facilitates improved systematic lymphadenectomies assisting with more accurate staging for lung cancer patients. As is evident in our patient cohort, RATS results in a shorter length of hospitalisation, facilitating a faster overall recovery time with the ability to return to normal activity.
There were no mortalities in our patient cohort.
Literature reports a post-operative length of stay averaging 4 days Training for patients undergoing for robotic surgery can be a paradigm shift for surgeons, RATS procedures. Early results from the RAVAL (Robotic-assisted video-assisted who versus are a group used to learning new techniques and approaches, lobectomy for lung cancer) trial, as well as prospective studies,givenhave shown reduced that the surgeon sits at a beside the mortality, hospital stay and complication rates (28-45%). Patients console also un-scrubbed experience shorter patient controlling a number of robotic arms. The main robotic chest drain duration and reduced post-operative pain. platform in use worldwide is the da
Following a year of robotic thoracic surgical procedures, we have reviewed the early outcomes of our expanding program combined with our enhanced recovery protocol. Patient outcomes including length of stay, chest drain duration, postoperative complications, as well as our robotic training program were examined.
Vinci® robotic platform produced by Intuitive Surgical Inc. At St James’s Hospital we have a dual console system comprising the latest da Vinci® Xi operating system. Training followed a pre-defined pathway involving initial online training, followed by simulator training on the da Vinci® Xi console at St James’s Hospital over a period covering approximately 30 hours. Surgical case observations were then undertaken overseas in Paris and London with international experts. The second stage of the training pathway involved local on-site training, with the Intuitive Surgical representative, involving both surgeon and theatre staff. Mr Fitzmaurice was the first Irishtrained surgeon to undergo 2-days of live simulation training as part of
Over the course of the first year, we have performed 32 robotic-assisted thoracic surgical operations in a stepwise incremental approach. This enabled the safe introduction of a new surgical technique within the department with a focus on case selection and staff engagement. The operations performed included diagnostic lymph node dissection, RATS does not, however, come thymectomies, sub-lobar resections, pleural-based chest wall tumour resections, and without challenges. Those specific Literature reports a post-operative to robotic surgery include high anatomical lobectomies. The median age ofcapital ourexpenditure patient cohort was 65 years with equal length of stay averaging 4 days costs and for patients undergoing RATS initial longer operating times distribution of gender. Our results demonstrated median chest drain duration of 1 day with procedures. Early results from with a a steep learning curve the RAVAL (Robotic-assisted for the entire surgical team. a median post-operative length of stay of 2 days. Pain was well controlled with intercostal versus video-assisted lobectomy Video-assisted thoracic surgery for lung cancer) trial, as well as RATS surgery has a number RATS share similar nerve blocks, patient control analgesia, and (VATS) oralandanalgesia that included paracetamol and prospective studies, have shown advantages when compared complications, although with reduced mortality, hospital stay to traditional open or minimally reducedin rates for RATSpatients including Ibuprofen with the occasional addition of opioids select on discharge. invasive thoracic surgical lower rates of blood loss, infection techniques. First, there is Figure 1: Chest drain duration and post-operative length of stay following RATS surgery
and prolonged air leak. The
Figure 1: Chest drain duration and post-operative length of stay following RATS surgery
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