| Purpose: a retrospective analysis of leonardo Da Vinci surgical robot system by hybrid operating room Dyna preoperative CT guiding the surrounding lung nodules grinding glass(pulmonary focal ground glass opacity,GGO)methylene blue positioning of relevant clinical and imaging data,discuss the indications,preoperative localization and analysis related to complications of multiple factors,and as far as possible to prevent or reduce the related complications.Materials and methods: this study retrospectively selected 192 patients with GGO lung resection by Da Vinci robotic surgery system admitted to the general hospital of the northern theater command from April 2012 to September 2019,including 95 males and 97 females,with an average age of 56.47 ± 11.79 years.There were 61 cases(32.1%)of lesions in the right upper lobe,17 cases(8.9%)in the middle lobe of the right lung,38 cases(20%)in the lower lobe of the right lung,39 cases(20.5%)in the left upper lobe,and 32 cases(16.8%)in the left lower lobe.Preoperative blood gas analysis,pulmonary function(lung capacity,forced lung capacity,one-second volume,maximum autonomous ventilation),electrocardiogram,color echocardiography of the heart,color doppler ultrasound of the abdominal organs,etc.,were completed in all patients,and distant metastasis was excluded.Preoperative tolerance to lobar or segmental lung resection was evaluated and included in the group.According to the substance composition,size of GGO and the depth of the lesion to the visceral pleura combined with the experience of the surgeon,the preoperative methylene blue positioning was decided.The patients were divided into the positioning group and the non-positioning group according to the preoperative CT guided injection of methylene blue around the lesion.Patients in the localization group were divided into the p GGO lesion group and the m GGO lesion group according to the different lesion composition;patients in the non-localization group were divided into the p GGO group and the m GGO group according to the different lesion composition.There was no statistically significant difference in the general data of patients in each group(P>0.05).All cases were analyzed according to the distance of the lesion to the visceral pleural depth and the maximum diameter of the lesion.In the scatter chart,the corresponding diameter and depth of the lesion as well as the reachable coordinate points were depicted,and the linear function was obtained by linear regression of all coordinate points.The purpose of postlocalization surgery is to perform radical surgery or to confirm pathological diagnosis for treatment.And on the basis of methylene blue positioning of pneumothorax,select all the 75 cases of patients,to study the related complications,using SPSS24.0 software for statistical analysis of continuous variables using average +/-standard,for measurement data using independent sample t-test analysis,for counting or hierarchical data using Pearson Chi-Square test is analyzed,when the sample < 5 using continuous correction chi-square chi-square.Variables with statistical differences(P<0.05)were screened out,and then binary Logistic regression analysis was performed,OR>1.0 P < 0.05 was considered statistically significant.Results: A total of 192 patients underwent Da Vinci robotic pulmonary segmentectomy,specific lymph node sampling,or pulmonary lobotomy and lymph node dissection.Preoperative methylene blue was used to locate the lesion size(9.81±1.54)mm from the visceral pleura(10.10±6.93)mm,and preoperative non-localized lesion size(13.14±2.31)mm from the visceral pleura(7.03±5.44)mm.The final pathology of lung lesions after operation: 74 cases of lung adenocarcinoma(38.5%),48 cases of microinvasive adenocarcinoma(25.0%),29 cases of carcinoma in situ(15.1%),and 41 cases of atypical adenomatous hyperplasia(21.3%).All lesions were classified into p GGO group(n=37)and m GGO group(n=155).The maximum lesion was about 29 mm,25mm away from the pleural surface of the visceral layer.All the patients were successfully removed by Da Vinci robotic surgery,and there was no change to thoracotomy.The number of lymph nodes sampled was(12.4±3.6),the operative time(autosectomies)was(108.1±19.43)min,the intraoperative blood loss was(49.3±19.8)m L,and the length of stay(from postoperative to discharge time)was(5.45±2.0)d.The number of lymph nodes sampled was(10.4±2.5),the operative time(128.5±20.7)min,the intraoperative blood loss(40.3±18.9)m L,and the length of stay(6.03±2.1)d.There was no statistically significant difference in the number of lymph node specific samples between the two groups(P=0.416),no statistically significant difference in intraoperative blood loss(P=0.057)and length of stay(P=0.066),and there was a statistical difference in operation time between the two groups(P=0.000).Lines preoperative methylene blue locating lesions lobectomy patients with the lymph node system,lymph node cleaning the number(24.5 + 5.6),the operation time(146.8 + 30.92)min,intraoperative blood loss(68.3 + 26.9)m L,length of hospital stay(8.43 + 2.8)d,preoperative patients with no positioning line lobectomy plus the lymph node system,number of lymph node cleaning for(22.6 + 3.9),the operation time(157.6 + 21.8)min,intraoperative blood loss(72.1 + 31.9)for m L,length of hospital stay(7.91 + 2.9)d.There were no statistically significant differences in the number of lymph node dissection(P= 0.246),operative time(P= 0.330),intraoperative blood loss(P=0.694),and length of stay(P=0.270).In the patients with specific lymph node sampling after lung segmentectomy,the preoperative operation time in the methylene blue positioning group(108.1±19.43)min was shorter than that in the non-positioning group(128.5±20.7)min),and the difference was statistically significant(P <0.01).In the patients undergoing lobectomy and lymph node dissection,the preoperative operation time of the focus group treated with methylene blue(146.8+30.92)min was shorter than that of the non-positioning group(157.6±21.8)min,but the difference was not statistically significant(P>0.05).The limitation of this retrospective study is that it is a single-institution study with certain bias,which should include more patients,more reliable data and more detailed positioning and puncture techniques.Based on the study of 192 Da Vinci robotic surgeries,the linear function was obtained: depth = 0.648 × diameter-1.446,unit(mm).It can be considered as an indication of p GGO preoperative localization for Da Vinci robotic surgery.Linear function: depth =0.5595× diameter +0.56(mm).It can be considered as an indication of preoperative localization of m GGO for Da Vinci robotic surgery.The correlation factors were substituted into the linear function.If the correlation factors were located above the linear function area,the possibility of nodule not being detected during the operation increased,then positioning should be considered.If it is located below the linear functional area,the possibility of intraoperative detection and nodules is high,and no positioning should be considered.The incidence of pneumothorax was 40%(8/20)in the p GGO group and30%(17/55)in the m GGO group,and the total incidence of pneumothorax complications was 33.3%(25/75).Respectively,the single factor analysis of the age,focal size,the lungs,lung puncture depth basic diseases,whether pierced leaf crack,positioning needle-dirty pleura between the Angle,the relationship between lesion location,etc and pneumothorax,select relevant factors,again multiariable Logistic regression analysis,the results show that pneumothorax happened related risk factors for positioning needle-dirty pleura Angle,positioning sort of number,and the size of the lesions.Conclusion:1.The operative time of the methylene blue group was shorter than that of the non-methylene blue group.The corresponding diameter and depth of the nodules and the coordinate points that can be detected or not are depicted in the scatter diagram,and the linear function is obtained by linear regression of all coordinate points: depth=0.648× diameter-1.446(unit is mm);It can be used as an indication for the preoperative localization of pure ground glass nodules in Da Vinci robotic surgery.Linear function: depth =0.5595× diameter +0.56(in mm);It can be used as an indication for the preoperative localization of mixed ground glass nodules in Da Vinci robotic surgery.2.The common complications were pneumothorax,pulmonary hemorrhage,irritating cough,less serious complications,the factors influencing the complicated with pneumothorax when positioning is more,the main factors,positioning needle lesion itself-dirty pleura and the choice of the number of angles,puncture,puncture needle, the multi-factor Logistic regression analysis showed that pneumothorax happened related risk factors for positioning needle-dirty pleura Angle,positioning sort of times,and the size of the lesions,and age,lung disease,whether pierced leaf between crack,lesion location,etc. |
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