| ObjectivesRobotic-assisted thoracic surgery (RATS) has become a promising treatment of pulmonary tumors. Intraoperative ultrasound can make a judgement of the location and pathologic quality of a pulmonary nodule. It will not only make up the shortcoming of the localization without touching in robotic-assisted surgery, but also provide a more intuitive way into the pathology. This study was aimed to investigate two issues-the efficacy and application scope of the localization of intraoperative ultrasound in da Vinci system, and the effectiveness and relevant factors of the judgement of the pathologic quality by intraoperative ultrasound.MethodsPatients of pulmonary nodules at the department of thoracic surgery were randomly divided into experimental and control groups. The nodules in the experimental group were localized by intraoperative ultrasonography, and those in the blank control group were localized by the surgeon’s experience based on chest CT. Compared the indicators including the time of operation, blood loss, postoperative drainage time, hospital stay and complications to determine the safety of ultrasonography. Compare the success rate of the two groups, analyze the influence of tumor size, depth, density on ultrasound locating, and definite its scope. Compare the sensitivity and specificity of the qualitation, and analyze the ultrasound characteristics which can prompt the pathological nature. Analyze the the learning curve of intraoperative ultrasonography, inspect the feasibility of operating independently by a surgeon.ResultsIn the experimental group, there were 7 women patients, taking up 35.0% of 20. The ages ranged from 19 to 78 years old, with a median of 59. In the control group, women took up 52.4% of 21 patients. The ages ranged from 22 to 80 years old, with a median of 57. There were no statistically significant difference of age (p= 0.690) and gender (p= 0.262) between the groups. The operation time was 89 minutes, the blood loss was 20 ml, the postoperative drainage time and hospital stay were 3 and 4 days in the experimental group, and one patients emerged complications. In the control group, the operation time was 104 minutes, the blood loss was 50 ml, the postoperative drainage time and hospital stay were 4 and 7 days, without complications reported. There were statistically significant difference of blood loss (p= 0.008) in advantage of experimental group, and no statistically significant difference of operation time (p= 0.197), postoperative drainage time (p= 0.339), hospital stay (p= 0.060), and complications (p= 0.488). It suggests that intraoperative ultrasound has good performance in safety. The ultrasound location for the nodules within 2 cm in depth had an efficacy of 93.8%, significantly better (p= 0.047) than the efficacy of 78.9% of the control group. The sensitivity, specificity and accuracy of ultrasound qualitation were 100%,80.0% and 93.3%. And those in the control group were 84.2%,57.1%, and 76.9%. There were only a tendency in the difference of the sensitivity (p= 0.532) and specificity (p= 0.576). The echo intensity (p= 0.020), echo uniformity (p= 0.020) and boundary definition (p= 0.043) were significantly associated with the pathological nature of nodules.ConclusionIt is demonstrated that the intraoperative ultrasound location of pulmonary nodules in the da Vinci system is effective for the nodules within 2 cm in depth, with an efficacy of 93.8%. The intraoperative ultrasound can also judge the pathologic quality of a nodule, regarding the echo intensity, echo uniformity and boundary definition, with an accuracy of 93.3%. It is really worthful to continue the study of carrying out the location and qualitation by intraoperative ultrasonography. |
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