Dual-site Robotic Surgery for Synchronous Primary Malignancies
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Robotics have begun being incorporated into the field of surgery over the past many years. Over this time, while significant innovation and research has been conducted for the efficiency and safety of them, the use of dual-site robotic surgery in synchronous malignancies in a single session has not been extensively reported.

 

Building on this, the first case of robotic surgery being carried out on the lung and oropharynx in a single session has been reported for the first time by surgeons in the Guy’s and St Thomas’ NHS Foundation Trust in London, UK.

 

In this case, a male (age 49) had been diagnosed with two primary malignancies: left tonsil squamous cell carcinoma and adenocarcinoma of right middle lobe of the lung. After a multidisciplinary discussion, it was decided that conventional surgery on the 2 separate anatomical locations may lead to significant morbidity. Therefore, a synchronous minimally invasive approach and subsequent adjuvant treatment was recommended.  This synchronous minimally invasive approach involved robot-assisted thoracic surgery (RATS) and transoral robotic surgery (TORS) using the DaVinci Xi system.

 

The DaVinci Xi system allows surgeons to perform robot-assisted minimally invasive surgery. The term “robotic” can be misleading as some come to believe that the robots perform surgery, however this is not the case. In fact, the DaVinci Xi system enables surgeons to perform surgery using instruments that that the surgeon guides via a console. The system translates the surgeon’s real-time hand movements on the console (figure 1), to the instruments performing the procedure (figure 2). Another part of the DaVinci Xi system is its ability to show 3D high-definition, greatly magnified views of the area to requiring surgery.

 



 

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Figure 1: Console at which the surgeon sits to control the instruments and view the surgical area in 3D

 

 





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Figure 2: The patient cart that contains the instruments controlled by the surgeon through the console and the camera to view the surgical location.
 


During the surgical session, the head and neck team begun by carrying out the left lateral oropharyngectomy., via transoral robotic surgery (TORS) over 90 minutes. Once this was complete, the single-lumen airway was replaced with a double lumen, as well as a paravertebral block inserted, requiring 20 minutes. After this, the thoracic team carried out the right middle and lower bilobectomy, as well as a full lymph node dissection via the robot, over 5 hours.
 
The surgical team involved in this case acknowledged that there were several challenges in carrying out two robotic-assisted procedures in a single session. However, by careful planning and teamwork, they were able to successfully carry out the two-site robotic surgery, with the use of robots allowing for precise dissection minimising nerve injury and bleeding during the procedure. Additionally, conventional open surgical approaches were considered to be higher risk and would have required a large time interval between the two surgeries, as well as long inpatient stays after each procedure.
 
Overall, this case report was able to add to the success of the use of robotics in the field of surgery in recent years.
 

 



References



  1. Kelly M, Oikonomou G, Tornari C, Ahmad I, Bille A, Jeannon J-P, et al. OUP accepted manuscript. J Surg Case Reports [Internet]. 2020 [cited 2020 Sep 5];2020(8):1–3. Available from: /pmc/articles/PMC7449555/?report=abstract

  2. Da Vinci Surgery | Da Vinci Surgical System | Robotic Technology [Internet]. [cited 2020 Sep 5]. Available from: https://www.davincisurgery.com/da-vinci-systems/about-da-vinci-systems


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Originally published 22 September 2020 , updated 22/09/2020

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