Page 11 - Read Online

Page 6 of 9 Durand. Mini-invasive Surg 2019;3:35 I http://dx.doi.org/10.20517/2574-1225.2019.31

Table 1. Chronological description of the characteristics of patients and procedures
Patient Procedure Sex Age (years) ASA BMI FEV (%) Tumor size (mm) Number of nodes Pathology
1 RUL + ML M 36 2 27 99 25 20 Carcinoid
2 ML M 62 3 27 MD 30 15 SCC
3 ML + RIL M 17 1 22 85 12 6 Carcinoid
4 ML M 52 3 21 107 30 21 ADK
5 RUL F 65 2 18 96 15 21 SCC
6 S6R M 70 2 22 64 85 14 SCC
7 RIL M 60 3 25 75 20 25 SCC
8 RUL M 55 2 25 107 25 19 Carcinoid
9 ML + RIL M 77 3 19 96 26 30 SCC
10 RUL M 42 2 21 101 12 9 Carcinoid
Median [Min; Max] 58 [17; 77] 2 [1; 3] 22 [18; 27] 96 [64; 10] 25 [12; 85] 19.5 [6; 30]
ML: median lobectomy; RUL: right upper lobectomy; RIL: right inferior lobectomy; S6R: segment 6 right lung; MD, missing data; SCC:
squamous cell carcinoma; ADK: adenocarcinoma

Table 2. Details of patients’ procedures, outcomes, and complications
Sleeve Surgery Blood loss Chest tube Complication
Patient N staplers LOS (d) Clavien dindo Complication type
procedure duration (min) (mL) (d) (yes 1, no 0)
1 RUL + ML 1 141 5 2 4 0 0
2 ML 6 243 150 5 7 0 0
3 ML + RIL 4 121 5 5 7 1 2 Chylothorax
4 ML 8 227 50 10 12 1 2 Air leak > 5 days
5 RUL 5 141 5 3 12 1 2 Pneumothorax
6 S6R 8 156 100 6 9 1 2 Bronchitis
7 RIL 5 125 5 4 19 1 5 Gastric hemorrhage
8 RUL 4 125 50 2 4 0 0
9 ML + RIL 6 189 50 7 20 1 2 Air leak > 5 days
10 RUL 3 176 150 4 7 1 2 Atelectasis
Mean (± SD) 5 (± 2.2) 164 (± 43) 57 (± 57) 4.8 (± 2.4) 10 (± 5.7)
ML: median lobectomy; RUL: right upper lobectomy; RIL: right inferior lobectomy; S6R: segment 6 right lung; LOS: length of stay; SD:
standard deviation

to allow open surgery procedures in a closed chest. This means that the procedure flow is the same as the
open surgery gold standard.

In our experience, we have had no conversions. We found a longer LOS in this group rather than standard
[6]
procedure or those described in . First, patients requiring this procedure might have comorbidities and
thus are at risk of complications, thereby requiring more hospital care. Second, the postoperative risk
concerns mainly the scaring process on the bronchus, which requires a closer check of the patients and thus
a longer length of stay. The aim of this surgery is not the quickest outcome but a good outcome that spares
the lung. In our series, 1 patient died during hospital stay of massive gastric hemorrhage. After analyzing
this case during a dedicated mortality meeting, this dramatic outcome was not found to be related to
the surgical approach. The patients’ comorbidities and the stress of such disease are real. This highlights
the severity of the underlying pathologies and risks. We do not understate the harshness of disease and
surgical risks due to miniaturization of thoracic penetration, especially for complex procedures.

Our 1st sleeve procedure was achieved for Patient 219, i.e., after significant experience with the machine.
This might have given the surgeon time to be technically confident and therefore appropriate for the patient
case. The learning curve for complex procedures depends on the surgeon’s self-appreciation and cannot be
[7]
estimated as in standard procedures at around 30 cases . For complex procedures, the surgeon’s mastery of
the tool is the 1st step and remains based on their honest capacity assessment. The other restricting element
is patient selection. As shown in our experience, these are rare indications (2%). We are aware of the patient