Report on first international workshop on robotic surgery in thoracic oncology

A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly

Mantle-derived CO2 migration along active faults within an extensional basin margin (Fiumicino, Rome, Italy)

Fluid migration along faults can be highly complex and spatially variable, with the potential for channeled flow, accumulation in capped porous units, fault cross-flow, lateral migration along strike, or complete sealing. Extensional basin margins can be important for such migration, given the associated crustal thinning and decompression that takes place combined with potential geothermal or mantle gas sources. One such example is near the urban area of Rome, situated along the active extensional continental margin of the Tyrrhenian back arc basin and surrounded by Middle-Upper Pleistocene K-rich and arc-related volcanoes. Recent research activities in the area around Fiumicino, a town 25 km to the west of Rome, has highlighted the close spatial link between degassing CO2 and the faults that provide the necessary vertical migration pathways. In particular, detailed soil gas and gas flux surveys have highlighted the release at surface of large volumes of asthenospheric mantle CO2 in correspondence with normal faults observed in a new seismic reflection profile acquired along the Tiber River. Detailed reconstruction of the Pleistocene–Holocene stratigraphy of the area dates fault activity from 20,000 to 9000 years BP. It is proposed that the gas migrates preferentially along the cataclastic tectonic breccias of the faults until it encounters recent, unconsolidated sediments; porous units within this shallow stratigraphy act as temporary secondary traps for the leaking gas,with local gas release at the ground surface occurring where the sealing of the overlying aquitards has been compromised. Degassing and active faults confirm the extensional tectonics affecting the area and the geodynamic scenario of a mantle wedge beneath the western Apennines, associated with ongoing W-directed subduction. Moreover, degassing highlights the potential geochemical and seismic risks for the highly populated urban areas near Rome

Robot-assisted pancreatoduodenectomy with the da Vinci Xi: can the costs of advanced technology be offset by clinical advantages? A case-matched cost analysis versus open approach

Background: Robot-assisted pancreatoduodenectomy (RPD) has shown some advantages over open pancreatoduodenectomy (OPD) but few studies have reported a cost analysis between the two techniques. We conducted a structured cost-analysis comparing pancreatoduodenectomy performed with the use of the da Vinci Xi, and the traditional open approach, and considering healthcare direct costs associated with the intervention and the short-term post-operative course. Materials and methods: Twenty RPD and 194 OPD performed between January 2011 and December 2020 by the same operator at our high-volume multidisciplinary center for robot-assisted surgery and for pancreatic surgery, were retrospectively analyzed. Two comparable groups of 20 patients (Xi-RPD-group) and 40 patients (OPD-group) were obtained matching 1:2 the RPD-group with the OPD-group. Perioperative data and overall costs, including overall variable costs (OVCs) and fixed costs, were compared. Results: No difference was reported in mean operative time: 428 min for Xi-RPD-group versus 404 min for OPD, p = 0.212. The median overall length of hospital stay was significantly lower in the Xi-RPD-group: 10 days versus 16 days, p = 0.001. In the Xi-RPD-group, consumable costs were significantly higher (€6149.2 versus €1267.4, p < 0.001), while hospital stay costs were significantly lower: €5231.6 versus €8180 (p = 0.001). No significant differences were found in terms of OVCs: €13,483.4 in Xi-RPD-group versus €11,879.8 in OPD-group (p = 0.076). Conclusions: Robot-assisted surgery is more expensive because of higher acquisition and maintenance costs. However, although RPD is associated to higher material costs, the advantages of the robotic system associated to lower hospital stay costs and the absence of difference in terms of personnel costs thanks to the similar operative time with respect to OPD, make the OVCs of the two techniques no longer different. Hence, the higher costs of advanced technology can be partially compensated by clinical advantages, particularly within a high-volume multidisciplinary center for both robot-assisted and pancreatic surgery. These preliminary data need confirmation by further studies