VATS肺癌精准手术.pptVIP

Robotic LobectomyPosition Comparison of 3 or more ports Huge Arms?3 or more ports 3 ports lung clamps、stapler or suction with arms through one port 5 or 6 ports much more easier insertion of lung clamps, staple or suction 4 ports(personal experience) easier insertion of lung clamps, staple or suction Robotic LobectomyPorts placement(1) City of Hope Medical Center and Beckman Research Institute, Duarte,California Robotic LobectomyPorts placement(2) Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York Personal Experience(4 Ports) 肺钳或stapler 左臂 右臂 The Selection of Endowrist（personal experience） Left Arm－cardiere clamp Right Arm－cardiere clamp、harmonic Decreasing the times types of Endowrist ? Shorten Operative time Decreasing economic cost Robot vs VATS LobectomyPosition Ports Placement Huge Robot Huge Arms Multiple joints ? difficult position, time-consuming Robot vs VATS LobectomyAnatomic Dissection(personal experience) 3D view for operator, 2D for assistant； Abundant experience on VATS lobectomy； Unconvenient without stapler; Less or more reliant on assistants? Robot vs VATS LobectomyAnatomic Dissection(personal experience) The lack of appropriate lung clamp Add cost in Shanghai, China Cost in US: convention＞robot＞VATS Park BJ, Flores RM. Thorac Surg Clin. 2008 Aug; 18(3):297-300, vii 单孔胸腔镜肺癌手术 手术后疼痛更轻，但无循证依据 切口少——美容？ 团队协作要求高 手术时间长？ 单孔胸腔镜肺癌手术 切口选择更谨慎 决定了肺门解剖和钉枪置放的难易和先后次序 腋前—中线 上叶—第4肋间；中叶—第3肋间；下叶—第5肋间 解剖程序模式的改变 上中叶—钉枪置放前下到后上，必须充分考虑 解剖结构处理的先后次序 引流管置放位置欠佳 充分引流和细致观察 四. 淋巴结的处理 肺部肿瘤根治手术——“骨骼化” 纵隔结构－“骨骼化” 肺门结构－“骨骼化” 骨骼化的风险 血管——大出血 气管支气管——气道瘘 食管——食管瘘 淋巴管——乳糜胸 神经——声嘶、膈麻痹 THE DEFINITION OF COMPLETE RESECTION FOR LYMPH NODES(IASLC,2005) at least 3 of #10,11,12 At least 3 of mediastinal lymph nodes: a)RUL,RML—#2,3,4,7 b）RLL—#4,7,8,9 c）LUL—#3A,5,7 d）LLL—#7,8,9 Ramon Rami-Porta,