Robotic lobectomy has the greatest benefit in patients with marginal pulmonary function

Abstract Background Patients with limited pulmonary function have a high risk for pulmonary complications following lobectomy. Robotic approach is currently the least invasive approach. We hypothesized that robotic lobectomy may be of particular benefit in high-risk patients. Methods We reviewed our institutional Society of Thoracic Surgeons (STS) data on lobectomy patients from 2012 to 2017. Postoperative outcomes were compared between robotic and open lobectomy groups. High-risk patients were identified by pulmonary function test. Risk of pulmonary complication was assessed by binary logistic regression analysis. Results A total of 599 patients underwent lobectomy by robotic (n = 287), or by open (n = 312) approach, including 189 high-risk patients. Robotic lobectomy patients had a lower rate of prolonged air leak (6% vs. 10%, p = 0.047), less atelectasis requiring bronchoscopy (6% vs. 16%, p = 0.02), pneumonia (3% vs. 8%, p = 0.01), and shorter length of stay (4 vs. 6 days, p = 0.001). Overall pulmonary complication rate was significantly lower after robotic lobectomy in high-risk patients (28% vs. 45%, p = 0.02), less in intermediate or low risk patients. No significant difference was seen relative to major complication rate (12% vs. 17%, p = 0.09). After multivariate analysis, when adjusting for age, gender, smoking history, FEV1, DLCO, cardiopulmonary comorbidities, and prior chest surgery, the robotic approach remained independently associated with decreased pulmonary complications (odds ratio 0.54, 95% confidence interval [0.34–0.85], p = 0.008). Conclusions Robotic lobectomy has the potential to decrease the risk of postoperative pulmonary complication as compared with traditional open thoracotomy. In particular, patients with limited pulmonary function derive the most benefit from a robotic approach

Robotic lobectomy costs and quality of life

The surgical approach for lobectomy has changed over time with recent data demonstrating that the majority are performed using a minimally invasive approach. While the use of the robotic platform for pulmonary resection has been shown to have acceptable clinical outcomes, cost and quality of life need to be considered when starting a robotic lobectomy program. In this review, we evaluate the literature on cost of robotic lobectomy and quality of life. The results suggest that early experience in a robotic lobectomy program may be associated with relatively higher index hospital costs when compared to video-assisted thoracoscopic surgery; however, with increased experience and volume, the difference may no longer be of significance. When compared with thoracotomy, the cost is comparable if not less costly and may even be profitable for the hospital. Quality of life appears to be acceptable in the early experience of robotic lobectomy

Linear Endobronchial Ultrasound in the Era of Personalized Lung Cancer Diagnostics-A Technical Review

Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasingly become one of the main sources of tumor cells for molecular analyses. As a result, there is a growing need for high quality EBUS-TBNA samples with adequate cellularity. This has increased the technical demands of the procedure and has created additional challenges, many of which are not addressed in the current EBUS guidelines. This review provides an overview of current evidence on the technical aspects of EBUS-TBNA in light of comprehensive sample processing for personalized lung cancer management. These include sonographic lymph node characterization, optimal needle choice, suction biopsy technique, and the role of rapid on-site evaluation. Attention to these technical details will be important to maximize the throughput of EBUS-TBNA biopsies for molecular testing

Biomechanischer In-vitro-Vergleich von vier Minischrauben zur skelettalen Verankerung im Kiefer- und Gesichtsbereich

In dieser Arbeit wurden vier Minischraubentypen (Aarhus, FAMI, Dual Top und Spider) auf ihre biomechanischen Eigenschaften im Bezug auf die Primärstabilität untersucht. Eindrehmoment-, Lösemomentmessungen und Ausreißversuche in axialer (0°) sowie in 20°- und 40°-Zugrichtung wurden durchgeführt, sowie Testreihen mit und ohne Pilotbohrung vorgenommen. Die Steifigkeit des Schrauben-Knochen-Konstruktes wurde anhand der Kraft-Verformungskurve berechnet. Als Knochentestmaterial dienten bovine Femurköpfe, welche auf ein Kollektiv mit Knochendichten (BMD) zwischen 500-600 mgHa/cm³ begrenzt wurden. Im Vergleich zu dem zylindrischen Aarhus- und Spider Schrauben erreichten die konischen FAMI- und Dual Top Schrauben statistisch signifikant höhere Eindrehmomente (p=0,001). Durch die selbstbohrende Insertion der FAMI- und Dual Top Schrauben konnten die Eindrehmomente statistisch signifikant erhöht werden (p=0,001). In den Ausreißversuchen ergaben sich statistisch signifikante Unterschiede zwischen den vier Schraubentypen. Die hochsignifikanten Unterschiede, die zwischen den vier Schrauben für die Ausreißkräfte in axialer (0°) und 20°-Zugrichtung festgestellt wurden, waren für die Werte in 40°-Zugrichtung nicht ersichtlich. Verglichen mit den Ausreißkräften in axialer Zugrichtung steigerten sich die Ausreißkräfte der konischen FAMI- und Dual Top Schrauben unter 20° angulärer Zugrichtung, doch verringerten sich die Ausreißkräfte bei den zylindrischen Schrauben mit dem Winkel deutlich. Die Dual Top Schraube erreichte in allen Testreihen die höchsten Werte für Ausreißkraft und Steifigkeit. 12 Dual Top- und 1 Spider Schraubeköpfe frakturierten während den Ausreißversuchen. Es konnte gezeigt werden, dass konische selbstbohrende Schrauben, im Vergleich mit zylindrischen selbstschneidenden Schrauben, eine höhere Primärstabilität erreichen. Diese Überlegenheit war in den Drehmomentmessungen deutlicher als in den Ausreißversuchen zu sehen

A Prospective, Randomized Trial for the Comparison of 19-G and 22-G Endobronchial Ultrasound-Guided Transbronchial Aspiration Needles; Introducing a Novel End Point of Sample Weight Corrected for Blood Content

Background The use of 22- or 21-gauge (G) endobronchial ultrasound (EBUS) needles are recommended for lung cancer diagnosis and staging. Performance of detailed molecular workup and programmed death ligand 1 (PD-L1) staining in lung cancer patients increases the demand for tissue. The aim of this prospective, randomized two-center trial was to compare 19-G and 22-G EBUS needles regarding tissue quality, diagnostic yield, feasibility, safety, performance, and blood content. Patients and Methods Patients with a computed tomography scan indicative of lung cancer with mediastinal or hilar lymph node metastases were prospectively enrolled and randomized for the use of either a 19-G or a 22-G EBUS needle. A blood content score from 0 to 2 was applied. Samples were weighed, tumor cells were counted per slide, and complications and final diagnoses were documented. Results We enrolled 107 patients (53 [49.5%] in the 19-G group/54 [50.5%] in the 22-G group) and samples were weighed immediately after performing EBUS. Samples obtained with a 19-G needle contained significantly more tissue (P = .0119). Non–small-cell lung cancer-infiltrated EBUS samples contained significantly more tumor cells when sampled with a 19-G needle (P = .0312). The diagnostic yield was equally adequate in both groups. Four moderate EBUS-related bleedings occurred (2 per group), hemostasis was rapidly achieved in all cases. Further complications did not occur. Conclusion Endobronchial ultrasound-guided transbronchial needle aspirations with a 19-G needle contain significantly more tissue and tumor cells per slide with a safety profile similar to 22-G needles. Further research is needed to investigate the relevance of this finding in terms of molecular analyses and PD-L1 staining