Lobectomías robóticas y cáncer de pulmón. Experiencia inicial en nuestro centro / Robotic lobectomies and lung cancer. Initial experience in our center

Objetivo: Analizar la seguridad y factibilidad en términos de resultados obtenidos en las primeras lobectomías robóticas realizadas en nuestro centro. Metodología: Estudio prospectivo desde mayo hasta diciembre de 2021 en 13 pacientes (11 hombres y 2 mujeres, edad media 59 años) con carcinoma de pulmón en estadios precoces tributarios de lobectomía robótica.Se utilizó el sistema da Vinci Xi con cuatro puertos y uno asistente. Resultados: Se realizaron 13 lobectomías robóticas. La conversión a cirugía videoasistida fue necesaria en 2 pacientes (15,4%). Se produjeron complicaciones en 3 pacientes (23%). La mediana de tiempo quirúrgico fue180 minutos [IQR 150-210]. La mediana de estancia hospitalaria fue de 4 días [IQR 3 - 6]. La mediana de duración del drenaje pleural fue de 4 días [IQR3 - 6]. La histología predominante fue carcinoma epidermoide en5 pacientes (39%). La media de ganglios linfáticos resecados fue de 15 (IC 95%: 11 - 19) y la de estaciones ganglionares de 5 (IC 95%: 4 - 5). No hubo mortalidad postoperatoria. El estadio postquirúrgico fue IA2 en 4 pacientes (31%), IB en 3 (23%), IIB en 2 (15%), y IIIA en 1 (7%). No se establecen diferencias estadísticamente significativas entre el IMC, el lóbulo resecado y la presencia de complicaciones (p = 0,5; p = 0,2), ni entre el número de ganglios resecados/número de estaciones ganglionares, y el estadio tumoral (p = 0,4; p = 0,9). Conclusiones: La lobectomía robótica con linfadenectomía hiliomediastínica es factible y segura. Es necesaria mayor experiencia y seguimiento a largo plazo para una adecuada evaluación de los resultados postoperatorios, la eficacia oncológica, y la comparación con las vías de abordaje convencionales. (AU)

Objectives: analyze the safety and feasibility in terms of results obtained in the first robotic lobectomies performed in our center. Method: prospective study from May to December 2021 in 13 patients (11 men and 2 women, mean age 59 years) with lung carcinoma in early stages requiring robotic lobectomy. The da Vinci Xi system was used with four ports and one assistant. Results: 13 robotic lobectomies were performed. Conversion to video-assisted surgery was necessary in 2 patients (15.4%). Complications occurred in 3 patients (23%). The median surgical time was 180 minutes [IQR 150-210]. The median hospital stay was 4 days [IQR 3 - 6]. The median duration of pleural drainage was 4 days [IQR3 - 6]. The predominant histology was squamous cell carcinoma in 5 patients (39%). The mean number of lymph nodes resected was 15 (95% CI: 11 - 19) and the number of lymph nodes resected was 5 (95% CI: 4 - 5). There was no postoperative mortality. The postsurgical stage was IA2 in 4 patients (31%), IB in 3 (23%), IIB in 2 (15%), and IIIA in 1 (7%). No statistically significant differences were established between BMI, the resected lobe and the presence of complications (p = 0.5; p = 0.2), nor between the number of resected lymph nodes/number of lymph node stations, and the tumor stage ( p = 0.4; p = 0.9).Conclusions: robotic lobectomy with hiliomediastinal lymphadenectomy is feasible and safe. Greater experience and long-term follow-up are necessary for an adequate evaluation of postoperative results, oncological efficacy, and comparison with conventional approaches. (AU)

Modelling Particle Transport and Deposition in the Human Healthy and Stented Tracheobronchial Airways.

The main goal of this study is the quantification of the particle transport and deposition within the human airways during light, normal and exercise breathing conditions using the computational fluid dynamics. In particular we presented a comparison between healthy and stented airways. The considered tracheobronchial model is based on the Weibel symmetric model in which we have inserted the Dumon prosthesis at different locations and on the CT-based geometries of a healthy and a stented airway. The results indicate an important redistribution of the particle deposition locations. Local overdoses can be found in the proximal regions of the prostheses, independently of the breathing conditions, of the particle size and of the considered geometry. The presented work is aimed to contribute to the understanding of the particle deposition in the human lung and to improve drug-aerosol therapies. For patients that underwent airways reconstructive surgery, it can give detailed information about the deposition efficiency and it may help targeting specific airways regions.