Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Shiyuan ^1,2 , WU Ziheng ^2,3 , XU Wei ² , WU Qiong ² , XU Shiguang ² , LIU Bo ² , DING Renquan ² , WANG Xilong ² , HU Yuhang ² ,  WANG Shumin ²

1. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, 110016, P. R. China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Medical College of Zhejiang University, Hangzhou, 310009, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Totally no tube; Da Vinci robot surgery system; mediastinal tumor; postoperative hospital stay; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202111028

Video：

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Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. Methods The clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). Results A total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. Conclusion Robot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.

Citation： SONG Shiyuan, WU Ziheng, XU Wei, WU Qiong, XU Shiguang, LIU Bo, DING Renquan, WANG Xilong, HU Yuhang, WANG Shumin. Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1396-1401. doi: 10.7507/1007-4848.202111028 Copy

1.	Kajiwara N, Taira M, Yoshida K, et al. Early experience using the Da Vinci surgical system for the treatment of mediastinal tumors. Gen Thorac Cardiovasc Surg, 2011, 59(10): 693-698.
2.	丁仁泉, 成名, 許世廣, 等. 達芬奇機器人完全無管化與經劍突下胸腔鏡手術治療胸腺腫瘤圍手術期效果的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2023, 30(6): 818-823.
3.	劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
4.	Roden AC, Fang W, Shen Y, et al. Distribution of mediastinal lesions across multi-institutional, international, radiology databases. J Thorac Oncol, 2020, 15(4): 568-579.
5.	彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
6.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
7.	Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
8.	Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
9.	Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the Da Vinci surgical system for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
10.	方文濤, 谷志濤, 陳克能, 等. 胸腺腫瘤微創手術研究進展. 中國肺癌雜志, 2018, 21(4): 269-272.
11.	中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
12.	Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
13.	沈誠, 李玨, 李鵬飛, 等. 加速康復外科評價指標: 病人報告結局在胸外科的臨床應用現狀與進展. 中國肺癌雜志, 2019, 22(3): 161-166.
14.	唐善衛, 武強, 束余聲. 肺癌術后胸腔閉式引流管理的現狀與進展. 中華胸部外科電子志, 2019, 6(3): 182-186.
15.	葉雄, 陳剛, 唐繼鳴, 等. 胸腔鏡微創術后不留置胸腔引流管在快速康復外科中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 112-114.
16.	Ozdamar D, Turna C, Kibar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation: A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
17.	Pan WZ, Du J, Zhang LY, et al. The roles of NF-κB in the development of lung injury after one-lung ventilation. Eur Rev Med Pharmacol Sci, 2018, 22(21): 7414-7422.
18.	Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
19.	Mao S, Du X, Ma J, et al. A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing Nuss procedure. J Thorac Dis, 2018, 10(6): 3216-3224.
20.	Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
21.	丁磊, 馬山, 王天佑, 等. 胸腔鏡聯合縱隔鏡胸腺擴大切除治療重癥肌無力. 中華外科雜志, 2010, 6(11): 474-475.
22.	Padilla Alarcón J, Pe?alver Cuesta JC. Experience with lung resection in a fast-track surgery program. Arch Bronconeumol, 2013, 49(3): 89-93.
23.	Zhao G, Huang Y, Chen X, et al. Research on fast track surgery application in lung cancer surgery. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 102-106.
24.	Wehberg KE, Jackson D, Walters J, et al. Fast track minimally invasive transmyocardial revascularization. Innovations (Phila), 2009, 4(4): 217-220.
25.	Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1): 58-63.
26.	Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.

1. Kajiwara N, Taira M, Yoshida K, et al. Early experience using the Da Vinci surgical system for the treatment of mediastinal tumors. Gen Thorac Cardiovasc Surg, 2011, 59(10): 693-698.
2. 丁仁泉, 成名, 許世廣, 等. 達芬奇機器人完全無管化與經劍突下胸腔鏡手術治療胸腺腫瘤圍手術期效果的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2023, 30(6): 818-823.
3. 劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
4. Roden AC, Fang W, Shen Y, et al. Distribution of mediastinal lesions across multi-institutional, international, radiology databases. J Thorac Oncol, 2020, 15(4): 568-579.
5. 彭凱明, 康明強, 林濟紅, 等. 經劍突下胸腔鏡手術治療前縱隔腫瘤療效分析. 中華胸部外科電子雜志, 2018, 5(1): 16-21.
6. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
7. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
8. Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
9. Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the Da Vinci surgical system for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
10. 方文濤, 谷志濤, 陳克能, 等. 胸腺腫瘤微創手術研究進展. 中國肺癌雜志, 2018, 21(4): 269-272.
11. 中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
12. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: A meta-analysis. Ann Surg, 2018, 268(2): 254-259.
13. 沈誠, 李玨, 李鵬飛, 等. 加速康復外科評價指標: 病人報告結局在胸外科的臨床應用現狀與進展. 中國肺癌雜志, 2019, 22(3): 161-166.
14. 唐善衛, 武強, 束余聲. 肺癌術后胸腔閉式引流管理的現狀與進展. 中華胸部外科電子志, 2019, 6(3): 182-186.
15. 葉雄, 陳剛, 唐繼鳴, 等. 胸腔鏡微創術后不留置胸腔引流管在快速康復外科中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 112-114.
16. Ozdamar D, Turna C, Kibar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation: A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
17. Pan WZ, Du J, Zhang LY, et al. The roles of NF-κB in the development of lung injury after one-lung ventilation. Eur Rev Med Pharmacol Sci, 2018, 22(21): 7414-7422.
18. Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
19. Mao S, Du X, Ma J, et al. A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing Nuss procedure. J Thorac Dis, 2018, 10(6): 3216-3224.
20. Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
21. 丁磊, 馬山, 王天佑, 等. 胸腔鏡聯合縱隔鏡胸腺擴大切除治療重癥肌無力. 中華外科雜志, 2010, 6(11): 474-475.
22. Padilla Alarcón J, Pe?alver Cuesta JC. Experience with lung resection in a fast-track surgery program. Arch Bronconeumol, 2013, 49(3): 89-93.
23. Zhao G, Huang Y, Chen X, et al. Research on fast track surgery application in lung cancer surgery. Zhongguo Fei Ai Za Zhi, 2010, 13(2): 102-106.
24. Wehberg KE, Jackson D, Walters J, et al. Fast track minimally invasive transmyocardial revascularization. Innovations (Phila), 2009, 4(4): 217-220.
25. Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1): 58-63.
26. Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization

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