Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Background: Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods: We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results: Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions: U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach.info:eu-repo/semantics/publishedVersio

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Background: Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods: We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results: Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions: U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach

Research priorities in prehabilitation for patients undergoing cancer surgery: an international Delphi study

Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Antalya İli Batı Kıyıları (Lara – Kalkan)'nın Ekonomik Amaçlı Deniz Algleri

Özet: Bu araştırma Antalya batı kıyılarında dağılım gösteren ekonomik olabilecek deniz alglerinin belirlenmesi amacıyla 5 istasyonda (Lara, Faselis, Beymelek, Kaş, Kalkan) mevsimsel örneklemelerle yürütülmüştür. Çalışma sonunda Rhodopyhta'dan Corallina elongata Ellis &amp; Solander, Corallina officinalis (Linnaeus), Gelidium capillaceum (S.G. Gmelin) Kützing, Gelidium latifolium (Greville) Bornet &amp; Thuret, Jania adhaerens Lamouroux, Jania rubens (Linnaeus) Lamouroux, Porphyra leucosticta Thuret; Heterokontophyta'dan Cystoseira compressa (Esper) Gerloff et Nizamuddin, Cystoseira crinita Duby, Cystoseira elegans Sauvageau, Cystoseira spinosa Sauvageau, Cystoseira stricta (Montagne) Sauvageau, Padina pavonica (Linnaeus) Thivy, Sargassum vulgare C. Agardh; Chlorophyta'dan Enteromorpha intestinalis (L.) Nees, Gayralia oxysperma (Kützing) K.L. Vinogradova ex Scagel et al. ve Ulva lactuca Linnaeus türlerinin bölgede önemli ekonomik potansiyelde oldukları saptanmıştır. Anahtar Kelimeler: Akdeniz, Antalya, ekonomik deniz algleri The Seaweeds for Economic Purosun of Antalya Province (Lara - Kalkan) West Coastwise Abstract: This study has been carried out with seasonal samples in five stations in order to determine commercial seaweed in west coast of Antalya Province (Lara, Phaselis, Beymelek, Kaş, Kalkan). At the end of study, Rhodophyta (Corallina elongata Ellis &amp; Solander, Corallina officinalis (Linnaeus), Gelidium capillaceum (S.G. Gmelin) Kützing, Gelidium latifolium (Greville) Bornet &amp; Thuret, Jania adhaerens Lamouroux, Jania rubens (Linnaeus) Lamouroux, Porphyra leucosticta Thuret), Heterokontophyta (Cystoseira compressa (Esper) Gerloff et Nizamuddin, Cystoseira crinita Duby, Cystoseira elegans Sauvageau, Cystoseira spinosa Sauvageau, Cystoseira stricta (Montagne) Sauvageau, Padina pavonica (Linnaeus) Thivy, Sargassum vulgare C. Agardh), Chlorophyta (Enteromorpha intestinalis (L.) Nees, Gayralia oxysperma (Kützing) K.L. Vinogradova ex Scagel et al. ve Ulva lactuca Linnaeus). Species belong to the families have been determined as an important economic potential in this region. Key Words: Mediterranean, Antalya, seaweeds for economic purposin

Antalya Batı Kıyılarının (Antalya – Kalkan) Makrobentik Deniz Algleri

Özet: Bu araştırma Antalya batı kıyıları (Antalya – Kalkan)'nda dağılım gösteren makrobentik deniz alglerinin belirlenmesi amacıyla 5 istasyonda (Lara, Phaselis, Beymelek, Kaş, Kalkan) mevsimsel örneklemelerle yürütülmüştür. Çalışma sonunda; Antalya batı kıyılarında makrobentik deniz alglerinden Rhodophyta ait 17; Heterokontophyta'dan 13 ve Chlorophyta'dan 6 olmak üzere toplam 36 takson belirlenmiştir. Bazı indikatör alg türleri ve bunların oranları dikkate alındığında bölgenin henüz temiz karakterde olduğu ve vejetasyonunun Doğu Akdeniz'in genel vejetasyonu ile benzerlik gösterdiği saptanmıştır. Rhodophyta'dan 4; Heterokontophyta'dan 3 ve Chlorophyta'dan 1 taksonun bölgenin yaygın türleri oldukları sonucuna varılmıştır. Anahtar Kelimeler: Akdeniz, makrobentik deniz algleri, Rhodophyta, Heterokontophyta,Chlorophyta Abstract: This study has been carried out with seasonal samples in five stations in order to determine macrobenthic marine algae in West coast of Antalya (Lara, Phaselis, Beymelek, Kaş, Kalkan). At the end of study, In total, 36 taxa including Rhodophyta (17 taxa), Heterokontophyta (13 taxa), Chlorophyta (6 taxa). The some indicator species and their rates are shown that the region is still clear and the vegetation of this region is similar to general vegetation structure of East Mediterranean. In conclusion, it is found that Rhodophyta 4 (taxa); from Heterokontophyta 3 (taxa); from Chlorophyta 1 (taxa) are common species of this region. Key Words: Mediterrenean, macrobenthic seaweeds, Rhodophyta, Heterokontophyta, Chlorophyt

EĞİRDİR GÖLÜ'NDE ELODEA CANADENSIS MICHAUX'İN İLK BİLDİRİMİ VE İSTİLASI ÜZERİNE BİR ARAŞTIRMA

Özet: Elodea canadensis Michaux (Hydrocharitacea: Spermatophyta) Türkiye'de ilk olarak 1980'li yıllarda Trakya'dan bildirilmiştir. Eğirdir Gölü'nde, 2005 yılında ilk kez gözlemlenen bu tür dört yıl içerisinde tüm göl alanını kaplayarak baskın konuma gelmiştir. Bu çalışmada, 2005-2008 yılları arasında Eğirdir Gölü'nden alınan E. canadensis'in bazı diagnostik özellikleri ve ilk görüldüğü yıldan günümüze değin göldeki yayılışına ilişkin tespitler ortaya konulmuştur. Anahtar kelimeler: Elodea canadensis, Eğirdir Gölü, istilacı tür, trofik düzey A STUDY ON THE FIRST RECORD OF ELODEA CANADENSIS MICHAUX AND ITS INVASION IN LAKE EĞİRDİR, TURKEY Abstract: Elodea canadensis Michaux (Hydrocharitacea: Spermatophyta) was firstly recorded in Thrace in Turkey by 1980s. Firstly observed in 2005 in Lake Eğirdir, it has become dominant in the following years spreading all the lake area. In this study, some biological features and notes on the distribution of the plant since first observation was recorded, between 2005 and 2008. Key words: Elodea canadensis, invasive species, Lake Eğirdir, trophic leve