Advertisement

Anesthesia for Robotic Thoracic Surgery

  • Javier Campos
Chapter

Abstract

The management of the robotic thoracic surgical patient requires the knowledge of minimally invasive surgery techniques involving the chest. Familiarity with the da Vinci® robot surgical system by the anesthesiologist is mandatory. Management of one-lung ventilation techniques with a left-sided double-lumen endotracheal tube or an independent bronchial blocker is required, along with flexible fiber optic bronchoscopy techniques. Patient positioning and prevention of complications such as nerve or crashing injuries, while the robotic system is used. Recognition of the hemodynamic effects of carbon dioxide (CO2) during insufflation in the chest is required. Potential for conversion to open thoracotomy or open procedure in the abdomen.

Keywords

Robotic thoracic surgery One-lung ventilation Robotic surgery and patient positioning Carbon dioxide insufflation Advantages and disadvantages of robotic surgery 

References

  1. 1.
    Tatooles AJ, Pappas PS, Gordon PJ, Slaughter MS. Minimally invasive mitral valve repair using the da Vinci robotic system. Ann Thorac Surg. 2004;77:1978–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Nifong LW, Chitwood WR, Pappas PS, Smith CR, Argenziano M, Starnes VA, et al. Robotic mitral valve surgery: a United States multicenter trial. J Thorac Cardiovasc Surg. 2005;129:1395–404.CrossRefPubMedGoogle Scholar
  3. 3.
    Rea F, Marulli G, Bortolotti L, Feltracco P, Zuin A, Sartori F. Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis. Ann Thorac Surg. 2006;8:455–9.CrossRefGoogle Scholar
  4. 4.
    Savitt MA, Gao G, Furnary AP, Swanson J, Gately HL, Handy JR. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg. 2005;79:450–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Kernstine KH, DeArmond DT, Shamoun DM, Campos JH. The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc. 2007;21:2285–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Mack MJ. Minimally invasive and robotic surgery. JAMA. 2001;285:568–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Campos JH. An update on robotic thoracic surgery and anesthesia. Curr Opin Anaesthesiol. 2010;23:1–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Bodner J, Wykypiel H, Wetscher G, Schmid T. First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg. 2004;25:844–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Rückert JC, Ismail M, Swierzy M, Sobel H, Rogalla P, Meisel A, et al. Thoracoscopic thymectomy with the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci. 2008;1132:329–35.CrossRefPubMedGoogle Scholar
  10. 10.
    Campos JH. Anaesthesia for robotic surgery: mediastinal mass resection and pulmonary resections. Anaesth Int. 2011:19–22.Google Scholar
  11. 11.
    Baraka A. Onset of neuromuscular block in myasthenic patients. Br J Anaesth. 1992;69:227–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002;69:31–7.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Pandey R, Elakkumanan LB, Garg R, Jyoti B, Mukund C, Chandralekha, et al. Brachial plexus injury after robotic-assisted thoracoscopic thymectomy. J Cardiothorac Vasc Anesth. 2009;23:584–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Bodner J, Wykypiel H, Greiner A, Kirchmayr W, Freund MC, Margreiter R, et al. Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg. 2004;78:259–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Buentzel J, Straube C, Heinz RC, Beham A, Emmert A, et al. Thymectomy via open surgery or robotic video assisted thoracic surgery: can a recommendation already be made? Medicine (Baltimore). 2017;96(24):e7161.CrossRefGoogle Scholar
  16. 16.
    Buentzel J, Heinz J, Hinterthaner M, Schöndube FA, Straube C, Roever C, et al. Robotic versus thoracoscopic thymectomy: the current evidence. Int J Med Robot. 2017; 13.Google Scholar
  17. 17.
    Kajiwara N, Kakihana M, Usuda J, Ohira T, Kawate N, Ikeda N. Extended indications for robotic surgery for posterior mediastinal tumors. Asian Cardiovasc Thorac Ann. 2012;20:308–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Cerfolio RJ, Bryant AS, Minnich DJ. Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg. 2012;143:1138–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Zhang L, Gao S. Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer: a system review and meta-analysis. Int J Clin Exp Med. 2015;8:17804–10.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Lee BE, Korst RJ, Kletsman E, Rutledge JR. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages? J Thorac Cardiovasc Surg. 2014;147:724–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Yang HX, Woo KM, Sima CS, Bains MS, Adusumilli PS, Huang J, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage I nonsmall cell lung Cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg. 2017;265:431–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Liang H, Liang W, Zhao L, Chen D, Zhang J, Zhang Y, et al. Robotic versus video-assisted lobectomy/Segmentectomy for lung Cancer: a meta-analysis. Ann Surg. 2017 (in press).Google Scholar
  24. 24.
    Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg. 2006;131:54–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Anderson CA, Filsoufi F, Aklog L, Farivar RS, Byrne JG, Adams DH. Robotic-assisted lung resection for malignant disease. Innovations. 2007;2:254–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Gharagozloo F, Margolis M, Tempesta B, Strother E, Najam F. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg. 2009;88:380–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Campos JH. Update on tracheobronchial anatomy and flexible fiberoptic bronchoscopy in thoracic anesthesia. Curr Opin Anaesthesiol. 2009;22:4–10.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Campos JH. Progress in lung separation. Thorac Surg Clin. 2005;15:71–83.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Nifong LW, Chitwood WR Jr. Challenges for the anesthesiologist: robotics? Anesth Analg. 2003;96:1–2.PubMedGoogle Scholar
  30. 30.
    Ye X, Xie L, Chen G, Tang JM, Ben XS. Robotic thoracic surgery versus video-assisted thoracic surgery for lung cancer: a meta-analysis. Interact Cardiovasc Thorac Surg. 2015;21:409–14.CrossRefPubMedGoogle Scholar
  31. 31.
    Kampe S, Lohmer J, Weinreich G, Hahn M, Stamatis G, Welter S. Epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy. J Cardiothorac Surg. 2013;8:127.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001;72:362–5.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes. Thorac Surg Clin. 2008;18:249–58.CrossRefPubMedGoogle Scholar
  34. 34.
    Kwon ST, Zhao L, Reddy RM, Chang AC, Orringer MB, Brummett CM, et al. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg. 2017;154:652–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS. Hemodynamic effects of carbon dioxide insufflation during thoracoscopy. Ann Thorac Surg. 1994;58:404–7.CrossRefGoogle Scholar
  36. 36.
    Ohtsuka T, Nakajima J, Kotsuka Y, Takamoto S. Hemodynamic response to intrapleural insufflation with hemipulmonary collapse. Surg Endosc. 2001;15:1327–30.CrossRefPubMedGoogle Scholar
  37. 37.
    El-Dawlatly AA, Al-Dohayan A, Samarkandi A, Algahdam F, Atef A. Right vs left side thoracoscopic sympathectomy: effects of carbon dioxide insufflation on haemodynamics. Ann Chir Gynaecol. 2001;90:206–8.PubMedGoogle Scholar
  38. 38.
    El-Dawlatly AA, Al-Dohayan A, Abdel-Meguid ME, Turkistani A, Alotaiby WM, Abdelaziz EM. Variations in dynamic lung compliance during endoscopic thoracic sympathectomy with carbon dioxide insufflation. Clin Auton Res. 2003;13(Suppl 1):I94–7.PubMedGoogle Scholar
  39. 39.
    Steenwyk B, Lyerly R. Advancements in robotic-assisted thoracic surgery. Anesthesiol Clin. 2012;30:699–708.CrossRefPubMedGoogle Scholar
  40. 40.
    Campos JH, Ueda K. Update on anesthetic complications of robotic thoracic surgery. Minerva Anestesiol. 2014;80:83–8.PubMedGoogle Scholar
  41. 41.
    Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JH, Yoder MR, et al. The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovasc Surg. 2004;127:1847–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Bodner JC, Zitt M, Ott H, Wetscher GJ, et al. Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors. Ann Thorac Surg. 2005;80:1202–6.CrossRefPubMedGoogle Scholar
  43. 43.
    van Hillegersberg R, Boone J, Draaisma WA, Broeders IA, et al. First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer. Surg Endosc. 2006;20:1435–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, et al. Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg. 2010;139:53–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Gutt CN, Bintintan VV, Köninger J, Müller-Stich BP, Reiter M, Büchler MW. Robotic-assisted transhiatal esophagectomy. Langenbeck's Arch Surg. 2006;391:428–34.CrossRefGoogle Scholar
  46. 46.
    Watson TJ. Robotic esophagectomy: is it an advance and what is the future? Ann Thorac Surg. 2008;85:757–9.CrossRefGoogle Scholar
  47. 47.
    Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012;36:1608–16.CrossRefPubMedGoogle Scholar
  48. 48.
    Dunn DH, Johnson EM, Morphew JA, Dilworth HP, Krueger JL, Banerji N. Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus. 2013;26:159–66.CrossRefPubMedGoogle Scholar
  49. 49.
    Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg. 2013;145:90–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Choi YS, Shim JK, Na S, Hong SB, Hong YW, Oh YJ. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy. Surg Endosc. 2009;23:2286–91.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Czibik G, D’Ancona G, Donias HW, Karamanoukian HL. Robotic cardiac surgery: present and future applications. J Cardiothorac Vasc Anesth. 2002;16:495–501.CrossRefPubMedGoogle Scholar
  52. 52.
    Hubens G, Ruppert M, Balliu L, Vaneerdeweg W. What have we learnt after two years working with the da Vinci robot system in digestive surgery? Acta Chir Belg. 2004;104:609–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AnesthesiaUniversity of Iowa Health Care, Roy and Lucille Carver College of MedicineIowa CityUSA

Personalised recommendations