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Article: Should Robotic Surgery Simulation Be Introduced in the Core Surgical Training Curriculum?

Bhakhri, Kunal / Harrison-Phipps, K / Harling, Leanne / Routledge, T

2021 Volume 8, Page(s) 595203

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-03-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2021.595203
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Article ; Online: Solitary fibrous tumour of the pleura: a rare cause of digital clubbing.

Vekaria, Bina Devji / Myerson, James / Routledge, Thomas / Zhang, Ting Ting

BMJ case reports

2022 Volume 15, Issue 10

Abstract: A woman in her early 70s was found to have incidental finger clubbing at a fracture clinic consultation for an unrelated problem. She reported no associated respiratory symptoms and was referred back to her General Practitioner for further investigation. ...

Abstract	A woman in her early 70s was found to have incidental finger clubbing at a fracture clinic consultation for an unrelated problem. She reported no associated respiratory symptoms and was referred back to her General Practitioner for further investigation. A chest radiograph revealed a large left-sided mass. This was characterised as a pleural-based mass on CT, resulting in localised atelectasis and mediastinal shift. A CT guided biopsy revealed histology consistent with a solitary fibrous tumour of the pleura and the patient was referred for thoracotomy and resection.
MeSH term(s)	Female ; Humans ; Hypertrophy ; Image-Guided Biopsy ; Osteoarthropathy, Secondary Hypertrophic/etiology ; Pleura/pathology ; Pleural Neoplasms/pathology ; Solitary Fibrous Tumor, Pleural/diagnosis ; Solitary Fibrous Tumor, Pleural/diagnostic imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2022-10-07
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-248048
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Article ; Online: Preclinical evaluation of Versius, an innovative device for use in robot-assisted thoracic surgery.

Aresu, Giuseppe / Dunning, Joel / Routledge, Tom / Bagan, Patrick / Slack, Mark

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2022 Volume 62, Issue 3

Abstract: Objectives: The adoption of robot-assisted thoracic surgery (RATS) has helped to overcome some of the challenges associated with surgeons performing conventional video-assisted thoracic surgery. The Versius Surgical System (CMR Surgical, Cambridge, UK) ... ...

Abstract	Objectives: The adoption of robot-assisted thoracic surgery (RATS) has helped to overcome some of the challenges associated with surgeons performing conventional video-assisted thoracic surgery. The Versius Surgical System (CMR Surgical, Cambridge, UK) has been developed iteratively in line with surgical team feedback to improve the surgeon's experience and patient outcomes. The goal of this study was to assess the use of the device in RATS in a preclinical setting and to fulfil Idea, Development, Exploration, Assessment, Long-Term Follow Up-Devices stage 1 (Idea). Methods: Four cadaveric sessions were conducted between November 2018 and December 2020, during which device performance in a range of thoracic operations was assessed. Procedures were categorized as either completed or not completed, and surgeons evaluated the device's ability to successfully complete necessary surgical steps. Port and bedside unit positions were recorded. Results: In total, 22/24 (91.7%) thoracic procedures were successfully completed, including 17/18 lobectomies, 2/3 thymectomies and 3/3 diaphragm plications, in 9 cadaver specimens. One thymectomy could not be completed due to cadaver anatomy and 1 lobectomy was not completed due a console system fault. Port and bedside unit configurations were successfully validated for all procedures, and lead surgeons deemed the device to be well-suited for thoracic surgery. Conclusions: This preclinical study demonstrated the successful use of the device in RATS in cadaveric models and supports progression to small-scale clinical studies, as part of Idea, Development, Exploration, Assessment, Long-Term Follow Up-Devices stage 2a (Development).
MeSH term(s)	Cadaver ; Humans ; Pneumonectomy/methods ; Robotics ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted/methods
Language	English
Publishing date	2022-04-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezac178
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Article: Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis.

Lampridis, Savvas / Maraschi, Alessandro / Le Reun, Corinne / Routledge, Tom / Billè, Andrea

Cancers

2023 Volume 15, Issue 8

Abstract: Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using ... ...

Abstract	Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients' performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min;
Language	English
Publishing date	2023-04-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15082391
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Article: A cost analysis of robotic vs. video-assisted thoracic surgery: The impact of the learning curve and the COVID-19 pandemic.

Harrison, Oliver J / Maraschi, Alessandro / Routledge, Tom / Lampridis, Savvas / LeReun, Corinne / Bille, Andrea

Frontiers in surgery

2023 Volume 10, Page(s) 1123329

Abstract: Introduction: Robot-assisted thoracoscopic surgery (RATS) is an alternative to video-assessed thoracoscopic surgery (VATS) for the treatment of lung cancer but concern exists regarding the high associated costs. The COVID-19 pandemic added further ... ...

Abstract	Introduction: Robot-assisted thoracoscopic surgery (RATS) is an alternative to video-assessed thoracoscopic surgery (VATS) for the treatment of lung cancer but concern exists regarding the high associated costs. The COVID-19 pandemic added further financial pressure to healthcare systems. This study investigated the impact of the learning curve on the cost-effectiveness of RATS lung resection and the financial impact of the COVID-19 pandemic on a RATS program. Methods: Patients undergoing RATS lung resection between January 2017 and December 2020 were prospectively followed. A matched cohort of VATS cases were analyzed in parallel. The first 100 and most recent 100 RATS cases performed at our institution were compared to assess the learning curve. Cases performed before and after March 2020 were compared to assess the impact of the COVID-19 pandemic. A comprehensive cost analysis of multiple theatre and postoperative data points was performed using Stata statistics package (v14.2). Results: 365 RATS cases were included. Median cost per procedure was £7,167 and theatre cost accounted for 70%. Major contributing factors to overall cost were operative time and postoperative length of stay. Cost per case was £640 less after passing the learning curve ( Discussion: Passing the learning curve is associated with a significant reduction in the theatre costs associated with RATS lung resection and is comparable with the cost of VATS. This study may underestimate the true cost benefit of passing the learning curve due to the effect of the COVID-19 pandemic on theatre costs. The COVID-19 pandemic made RATS lung resection more expensive due to prolonged hospital stay and increased readmission rate. The present study offers some evidence that the initial increased costs associated with RATS lung resection may be gradually offset as a program progresses.
Language	English
Publishing date	2023-04-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1123329
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Article ; Online: Resectability versus Operability in Early-Stage Non-Small Cell Lung Cancer.

Streit, Arthur / Lampridis, Savvas / Seitlinger, Joseph / Renaud, Stéphane / Routledge, Tom / Bille, Andrea

Current oncology reports

2023 Volume 26, Issue 1, Page(s) 55–64

Abstract: Purpose of review: With increased detection of early-stage non-small cell lung cancer (NSCLC) owing to screening, determining optimal management increasingly hinges on assessing resectability and operability. Resectability refers to the feasibility of ... ...

Abstract	Purpose of review: With increased detection of early-stage non-small cell lung cancer (NSCLC) owing to screening, determining optimal management increasingly hinges on assessing resectability and operability. Resectability refers to the feasibility of achieving microscopically negative margins based on tumour size, location and degree of local invasion and achieving an anatomical lobar resection. Operability reflects the patient's tolerance for resection based on comorbidities, cardiopulmonary reserve and frailty. Standardized criteria help guide these assessments, but application variability contributes to practice inconsistencies. This review synthesizes a strategic approach to evaluating resectability and operability in contemporary practice. Standardization promises reduced care variability and optimized patient selection to maximize curative outcomes in this new era of early detection. Recent findings: Recent pivotal trials demonstrate equivalency of sublobar resection to lobectomy for small, peripheral, node-negative NSCLC, expanding options for parenchymal preservation in borderline surgical candidates. Furthermore, recent phase 3 trials have highlighted the benefit of chemoimmunotherapy as a neoadjuvant treatment with an excellent pathological response and a down staging of the tumour, improving the resectability of the early-stage NSCLC. A good assessment of the operability and resectability is paramount in order to offer the best course of treatment for our patients. European and American societies have issued recommendations to help clinicians assess the cardiopulmonary function and predict the extension of pulmonary resection that could afford the patient. This operability assessment is closely linked with the evaluated tumour resectability which will determine the extension of pulmonary resection that is needed for the patient in order to achieve a good oncological outcome. Some major progresses have been done recently to improve the operability and resectability of patients. For instance, prehabilitation program allows better postoperative morbidity. Some studies have shown a potential good oncological outcome with sublobar resection expending access to surgery for patient with reduced lung function. Some others have identified the neoadjuvant immunochemotherapy as a potential solution for downstaging tumours. Work-up of early-stage NSCLC is a key moment and has to be done thoroughly and in full knowledge of the recent findings in order to propose the most appropriate treatment for the patient.
MeSH term(s)	Humans ; Carcinoma, Non-Small-Cell Lung/surgery ; Carcinoma, Non-Small-Cell Lung/pathology ; Lung Neoplasms/pathology ; Neoplasm Staging ; Pneumonectomy ; Small Cell Lung Carcinoma/pathology
Language	English
Publishing date	2023-12-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057359-5
ISSN	1534-6269 ; 1523-3790
ISSN (online)	1534-6269
ISSN	1523-3790
DOI	10.1007/s11912-023-01477-3
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Zs.A 5521: Show issues

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Article: Long-Term Oncologic Outcomes in Robot-Assisted and Video-Assisted Lobectomies for Non-Small Cell Lung Cancer.

Fabbri, Giulia / Femia, Federico / Lampridis, Savvas / Farinelli, Eleonora / Maraschi, Alessandro / Routledge, Tom / Bille, Andrea

Journal of clinical medicine

2023 Volume 12, Issue 20

Abstract: This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS ... ...

Abstract	This study compares long-term outcomes in patients undergoing video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC); all consecutive patients who underwent RATS or VATS lobectomy for NSCLC between July 2015 and December 2021 in our center were enrolled in a single-center prospective study. The primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence rate. The secondary outcomes were complication rate, length of hospitalization (LOS), duration of chest tubes (LOD), and number of lymph node stations harvested. A total of 619 patients treated with RATS (
Language	English
Publishing date	2023-10-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12206609
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Article ; Online: Learning curve of robotic surgery for lung cancer: analysis for two surgeons during the COVID-19 pandemic.

Streit, Arthur / Le Reun, Corinne / Lampridis, Savvas / Routledge, Tom / Billè, Andrea

General thoracic and cardiovascular surgery

2023 Volume 72, Issue 4, Page(s) 240–246

Abstract: Objective: To describe and compare the RATS learning curve between two surgeons in one department for lung cancer surgery using the CUSUM method.: Methods: Retrospective analysis using a prospective database on robotic-assisted lung resections ... ...

Abstract	Objective: To describe and compare the RATS learning curve between two surgeons in one department for lung cancer surgery using the CUSUM method. Methods: Retrospective analysis using a prospective database on robotic-assisted lung resections performed by two different surgeons in one hospital. The CUSUM method was used to describe the learning curve. Results: 366 consecutives cases were analysed (195 for the first surgeon and 171 for the second surgeon). A traditional 3-phase pattern learning curve was found with a diminution of the operating time throughout the different phases. For Surgeon 1, phase 1 was from case 1 to 59, phase 2 from case 60 to 99 and phase 3 started at case 100. For Surgeon 2, phase 1 was from 1 to 44, phase 2 from case 45 to 79 and phase 3 started at case 80. Conclusion: This study described our first experience with the Da Vinci Robotic System in our department. The curves had a similar shape which shows the learning curve of robotic surgery using the CUSUM method is reproducible. Furthermore, our results showed that the learning curve may improve after the programme starts in the department when the different team elements are all trained.
MeSH term(s)	Humans ; Robotic Surgical Procedures/methods ; Learning Curve ; Lung Neoplasms/surgery ; Retrospective Studies ; Pandemics ; Laparoscopy/methods ; Operative Time ; COVID-19/epidemiology ; Surgeons
Language	English
Publishing date	2023-09-13
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2376888-5
ISSN	1863-6713 ; 1863-6705
ISSN (online)	1863-6713
ISSN	1863-6705
DOI	10.1007/s11748-023-01976-x
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Article ; Online: Pneumomediastinum following intubation in COVID-19 patients: a case series.

Wali, A / Rizzo, V / Bille, A / Routledge, T / Chambers, A J

Anaesthesia

2020 Volume 75, Issue 8, Page(s) 1076–1081

Abstract: The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in ... ...

Abstract	The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.
MeSH term(s)	Adult ; Aged ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/therapy ; Fatal Outcome ; Female ; Humans ; Intubation, Intratracheal/adverse effects ; Male ; Mediastinal Emphysema/diagnostic imaging ; Mediastinal Emphysema/etiology ; Mediastinal Emphysema/therapy ; Middle Aged ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/therapy ; Prospective Studies ; Radiography, Thoracic ; Respiration, Artificial/methods ; SARS-CoV-2 ; Tomography, X-Ray Computed ; Trachea/injuries
Keywords	covid19
Language	English
Publishing date	2020-06-11
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.15113
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Article: Pneumomediastinum following intubation in COVID-19 patients: a case series

Wali, A / Rizzo, V / Bille, A / Routledge, T / Chambers, A J

Anaesthesia

Abstract	The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #197387
Database	COVID19

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