Background: A solitary pulmonary nodule (SPN) is defined as a round intraparenchimal lung lesion less than 3 cm in size, not associated with atelectasis or adenopathy. The aim of this study is to learn clinical experience of the treatment of SPN with Da Vinci Surgical System.
Methods: A total of 9 patients with solitary pulmonary nodules (SPN) less than 3 cm in diameter was treated with Da Vinci Surgical System (Intuitive Surgical, California) in thoracic surgery department from General Hospital of Shenyang Militrary Region from November 2011 to March 2014. This group of patients included 3 males and 6 females, and the mean age was 51±9.9 yr (range: 41-74 yr). Most of the patients were no obvious clinical symptoms (7 cases were found by physical examination, others were with cough and expectoration). Their median medical history was 12 mo (range: 4 d-3 yr). All the lesions of patients were peripheral pulmonary nodules and the mean diameter of those was (1.4±0.6) cm(range: 0.8-2.8 cm). Wedge-shaped resection or lobectomy was performed depending on the result of rapid pathology and systemic lymph node dissection was done for malignant leision. We used general anesthesis with double lumens trachea cannula. We set the patients in lateral decubitus position with jackknife. The patient cart enter from top of the patient. The position of trocars would be set according to the position of lesion. A 12 mm incision was positioned at the 8th intercostal space in the posterior axillary line as vision port, and two 8 mm incisions were positioned at the 5th intercostal space between the anterior axillary line and midclavicular line, and the 8th infrascapular line as robotic instrument ports about 10 cm apart from the vision port. One additional auxiliary small incision for instrument without retracting ribs was set at the 7th intercostal space in the middle axillary line.
Results: There were 4 benign leisions and 5 malignancies identified. Wedge-shaped resection was performed for 4 patients, lobectomy with systemic lymph node dissection for 3 patients (including 2 right middle lobectomies and 1 left upper lobectomy) and wedge-shaped resection with systemic lymph node dissection for 2 patients of poor lung function. All of the 9 cases were completed with total robotic procedure without conversion. The pathological results included 3 inflammatory pseudotumors, 1 hamartoma, 5 adenocarcinomas. All of the 29 patients were hospital discharged smoothly. The patients were followed up for 0.1-18.5 mo (median 11 mo) without recurrence or metastasis.
Conclusions: The SPN patients should be given active surgical treatments to improve the diagnose rate as well as the cure rate of early non-small cell lung cancer. Since da Vinci Surgical System is a safe and minimally invasive treatment for SPN, it has higher value to the diagnosis and treatment of SPN.
背景与目的 肺孤立结节（solitary pulmonary nodule, SPN）定义为一个圆形的直径小于3 cm的肺实质内的病变，不伴有肺不张和淋巴结病变。本研究旨在探讨达芬奇机器人治疗SPN的临床体会。方法 2011年11月-2014年3月，沈阳军区总医院应用达芬奇机器人治疗SPN 9例，其中男性3例；女性6例 ；年龄41岁-74岁，平均（51±9.9）岁；患者多数无明显临床症状（健康体检发现7例，咳嗽咳痰2例）；病史时间4天-3年（中位数12个月）；病变均为周围型肺结节病灶，直径为0.8 cm-2.8 cm，平均（1.4±0.6）cm；术中切取病变送冰冻病理检查，证实为恶性病变者行肺叶切除或楔形切除并常规清除肺门和纵隔淋巴结。手术采用全麻、双腔管气管插管，患者健侧卧位，胸部垫高，双手屈曲抱枕于头前，折刀位。孔位为腋后线第8肋间为进镜孔，肩胛线第8肋间、腋前线与锁中线间第5肋间为器械孔，腋中线第7肋间为辅助口。结果 术后病理为良性病变4例（炎性假瘤3例，错构瘤1例），恶性病变5例，均为腺癌。手术包括楔形切除4例，右肺中叶切除＋淋巴结清除术2例，左肺上叶切除＋淋巴结清除术1例，其余2例肺癌患者因为心肺功能差，病变小于2 cm，行楔形切除＋淋巴结清除术。9例均顺利完成机器人手术，所有患者无严重术后并发症，均顺利出院。随访时间为0.1个月-18.5个月（中位数11个月），无复发、转移。结论 SPN病变应该予以积极手术治疗，提高早期肺癌的诊断率和治愈率，达芬奇机器人手术对于SPN的治疗是一种安全、微创的手术方法，在SPN病变的诊治中具有较高的价值。