{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:35:22Z","timestamp":1786649722604,"version":"build-2736575974"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Robotic-assisted thoracic surgery (RATS), due to its multiple advantages, has revolutionized the medical field in recent years. Yet, its implementation has been slower compared to other surgical fields. More data on the benefits of RATS regarding patient outcomes are required to justify the high costs of equipment. This study aimed to expand our understanding of anesthetic management of RATS and to analyze the postoperative patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The r\u2013retrospective descriptive study of the clinical history of 50 patients who underwent RATS using Da Vinci dVX\u00ae between 2018 and 2021 in the Thoracic Surgery Department of a single-center university teaching hospital. Statistical analyses of the clinical\u2013demographic variables and those related to airway management, mechanical ventilation, intraoperative hemodynamics, and postoperative outcomes were carried out. Subgroup analysis of patient cases was performed based on the date of surgical intervention to compare the operating time, length of hospital stay, and postoperative complications as surrogates of the learning curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>92% of patients were easily intubated with double-lumen tubes (76% were VivaSight-DL and 12% standard double-lumen tubes) following the usual protocol, while in 8% of patients, a difficult airway was detected and lung isolation using bronchial blockers was performed. During the one-lung ventilation (OLV) period, 24.4% of patients suffered arterial hypotension and 19.5% required intravenous vasoconstrictors probably due to the capnothorax. The mean duration of the interventions was 135.4 minutes. The average hospital stay was 5.4 days on average, and the mean number of complications was 0.48% per person. No statistically significant difference was found between early and late patient subgroups in terms of operating time, length of hospital stay, and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>RATS is a safe intervention which is well managed anesthetically by the use of double-lumen tubes with embedded camera. The use of protective ventilation strategy, including optimal PEEP and lung recruitment maneuver, during one-lung ventilation is effective and hemodynamically well-tolerated in the majority of the patients (80%). The RATS approach is associated with short hospital stay and low postoperative complication incidence. Further studies are warranted to explore new anesthetic management techniques and compare the benefit of robot-assisted thoracic surgery with conventional surgical approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_174_24","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:00:46Z","timestamp":1752062446000},"page":"255-263","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of First 50 Robotic-Assisted Thoracic Surgeries in a University Teaching Hospital: Anesthetic Considerations and Postoperative Outcomes"],"prefix":"10.4103","volume":"28","author":[{"given":"Manuel","family":"Granell","sequence":"first","affiliation":[{"name":"Anesthesia Department, Consorcio Hospital General de Valencia, Spain"},{"name":"Department of Surgery, University of Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Mart\u00ednez-Plumed","sequence":"additional","affiliation":[{"name":"Anesthesia Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Garc\u00eda del Olmo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Valencia, Spain"},{"name":"Thoracic Surgery Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Pastor Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Valencia, Spain"},{"name":"Thoracic Surgery Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Grynovska","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Biosca P\u00e9rez","sequence":"additional","affiliation":[{"name":"Anesthesia Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Cervera Puchades","sequence":"additional","affiliation":[{"name":"Anesthesia Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"De Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Anesthesia Department, Consorcio Hospital General de Valencia, Spain"},{"name":"Department of Surgery, University of Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Guijarro Jorge","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Valencia, Spain"},{"name":"Thoracic Surgery Department, Consorcio Hospital General de Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"R1-20250709","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s00595-019-01793-x","article-title":"Current status of robot-assisted thoracoscopic surgery for lung cancer","volume":"49","author":"Kanzaki","year":"2019","journal-title":"Surg Today"},{"key":"R2-20250709","doi-asserted-by":"crossref","first-page":"70","DOI":"10.21037\/jtd.2020.01.22","article-title":"Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections","volume":"12","author":"Mazzei","year":"2020","journal-title":"J Thorac Dis"},{"key":"R3-20250709","doi-asserted-by":"crossref","first-page":"39","DOI":"10.21037\/jovs.2017.03.05","article-title":"Robotic lung cancer surgery: Review of experience and costs","volume":"3","author":"Novellis","year":"2017","journal-title":"J Vis Surg"},{"key":"R4-20250709","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ACO.0b013e3283336547","article-title":"An update on robotic thoracic surgery and anesthesia","volume":"23","author":"Campos","year":"2010","journal-title":"Curr Opin Anaesthesiol"},{"key":"R5-20250709","doi-asserted-by":"crossref","first-page":"263","DOI":"10.21037\/acs.2018.12.06","article-title":"Anesthesia for robotic thoracic surgery","volume":"8","author":"Pauli","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"R6-20250709","doi-asserted-by":"crossref","first-page":"6","DOI":"10.21037\/vats.2019.12.08","article-title":"Anesthesia considerations for robotic thoracic surgery","volume":"5","author":"Ruan","year":"2020","journal-title":"Video-assist Thorac Surg"},{"key":"R7-20250709","first-page":"71","article-title":"Anesthesia of robotic thoracic surgery","volume":"3","author":"Zhang","year":"2015","journal-title":"Ann Transl Med"},{"key":"R8-20250709","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1007\/s00268-016-3543-9","article-title":"30 years of robotic surgery","volume":"40","author":"Leal Ghezzi","year":"2016","journal-title":"World J Surg"},{"key":"R9-20250709","doi-asserted-by":"crossref","first-page":"S124","DOI":"10.1053\/j.jvca.2019.07.079","article-title":"Anesthesia in robotic thoracic surgery: Case series","volume":"33","author":"Granell","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R10-20250709","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1097\/SLA.0000000000003915","article-title":"Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): A systematic overview of reviews","volume":"273","author":"Muaddi","year":"2021","journal-title":"Ann Surg"},{"key":"R11-20250709","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.redar.2017.08.001","article-title":"Review of difficult airway management in thoracic surgery","volume":"65","author":"Granell","year":"2018","journal-title":"Rev Esp Anestesiol Reanim (Engl Ed)"},{"key":"R12-20250709","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.redar.2017.12.013","article-title":"Intubation in two patients with difficult airway management and tracheal stenosis after tracheostomy in thoracic surgery","volume":"65","author":"Granell Gil","year":"2018","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"R13-20250709","first-page":"83","article-title":"Update on anesthetic complications of robotic thoracic surgery","volume":"80","author":"Campos","year":"2014","journal-title":"Minerva Anestesiol"},{"key":"R14-20250709","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4103\/aca.aca_43_21","article-title":"Intubation with vivasight double-lumen tube versus conventional double-lumen tube in adult patients undergoing lung resection: A retrospective analysis","volume":"25","author":"Granell","year":"2022","journal-title":"Ann Card Anaesth"},{"key":"R15-20250709","doi-asserted-by":"crossref","first-page":"9628","DOI":"10.1111\/anae.13068","article-title":"Evaluation of a new doublelumen endobronchial tube with an integrated camera (VivaSightDL(\u2122)): A prospective multicentre observational study","volume":"70","author":"Koopman","year":"2015","journal-title":"Anaesthesia"},{"key":"R16-20250709","doi-asserted-by":"crossref","first-page":"356","DOI":"10.4103\/sja.sja_54_21","article-title":"Anesthesia for robotic thoracic surgery","volume":"15","author":"Gonsette","year":"2021","journal-title":"Saudi J Anaesth"},{"key":"R17-20250709","doi-asserted-by":"crossref","first-page":"839","DOI":"10.25237\/revchilanestv5004101556","article-title":"Abordaje anest\u00e9sico en cirug\u00eda tor\u00e1cica asistida por robot: Estudio de cohorte unic\u00e9ntrico","volume":"50","author":"\u00c1lvarez-Villegas","year":"2021","journal-title":"Rev Chil Anest"},{"key":"R18-20250709","first-page":"2068","article-title":"Right vs left side thoracoscopic sympathectomy: Effects of CO2 insufflation on haemodynamics","volume":"90","author":"ElDawlatly","year":"2001","journal-title":"Ann Chir Gynaecol"},{"key":"R19-20250709","doi-asserted-by":"crossref","first-page":"132730","DOI":"10.1007\/s00464-001-0037-z","article-title":"Hemodynamic responses to intrapleural insufflation with hemipulmonary collapse","volume":"15","author":"Ohtsuka","year":"2001","journal-title":"Surg Endosc"},{"key":"R20-20250709","doi-asserted-by":"crossref","first-page":"4274","DOI":"10.3390\/jcm11154274","article-title":"Anesthetic management during robotic-assisted minimal invasive thymectomy using the Da Vinci system: A single center experience","volume":"11","author":"Mohamed","year":"2022","journal-title":"J Clin Med"},{"key":"R21-20250709","doi-asserted-by":"crossref","first-page":"3558","DOI":"10.21037\/jtd.2018.05.179","article-title":"Postoperative morphine consumption and anaesthetic management of patients undergoing video-assisted or robotic-assisted lung resection: A prospective, propensity score-matched study","volume":"10","author":"Duclos","year":"2018","journal-title":"J Thorac Dis"},{"key":"R22-20250709","doi-asserted-by":"crossref","first-page":"206","DOI":"10.21037\/atm-22-4258","article-title":"Postoperative analgesia following robot-assisted thoracic surgery for mediastinal disease: Retrospective comparative study of general anesthesia alone, combined with epidural analgesia, and with ultrasound-guided thoracic paraspinal block","volume":"11","author":"Kusano","year":"2023","journal-title":"Ann Transl Med"},{"key":"R23-20250709","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.21037\/apm-20-1607","article-title":"Postoperative analgesia in patients undergoing robot-assisted thoracic surgery: A comparison between thoracic epidural analgesia and intercostal nerve block combined with intravenous patient-controlled analgesia","volume":"10","author":"Kawagoe","year":"2021","journal-title":"Ann Palliat Med"},{"key":"R24-20250709","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13063-019-3208-8","article-title":"Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): Study protocol for a randomized controlled trial","volume":"20","author":"Kiss","year":"2019","journal-title":"Trials"},{"key":"R25-20250709","doi-asserted-by":"crossref","first-page":"4126","DOI":"10.1007\/s00464-017-5464-6","article-title":"Robotic thoracic surgery results in shorter hospital stay and lower postoperative pain compared to open thoracotomy: A matched pairs analysis","volume":"31","author":"Darr","year":"2017","journal-title":"Surg Endosc"},{"key":"R26-20250709","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1186\/s12885-021-08241-5","article-title":"Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: A meta-analysis","volume":"21","author":"Ma","year":"2021","journal-title":"BMC Cancer"},{"key":"R27-20250709","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/codi.15398","article-title":"The robotic colorectal experience: An outcomes and learning curve analysis of 502 patients","volume":"23","author":"Parascandola","year":"2021","journal-title":"Colorectal Dis"},{"key":"R28-20250709","first-page":"289","article-title":"Robotically assisted lobectomy: Learning curve and complications","volume":"18","author":"Melfi","year":"2008","journal-title":"Thorac Cardiovasc Surg"},{"key":"R29-20250709","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.athoracsur.2009.04.039","article-title":"Robot-assisted lobectomy for early-stage lung cancer: Report of 100 consecutive cases","volume":"88","author":"Gharagozloo","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"R30-20250709","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.21037\/jtd.2019.05.71","article-title":"Learning curve for robot-assisted lobectomy of lung cancer","volume":"11","author":"Song","year":"2019","journal-title":"J Thorac Dis"},{"key":"R31-20250709","doi-asserted-by":"crossref","first-page":"3880","DOI":"10.1007\/s00464-019-07035-y","article-title":"Defining the learning curve of robotic thoracic surgery: What does it take?","volume":"33","author":"Power","year":"2019","journal-title":"Surg Endosc"},{"key":"R32-20250709","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s11701-018-00902-1","article-title":"Credentialing for robotic lobectomy: What is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon","volume":"13","author":"Baldonado","year":"2019","journal-title":"J Robot Surg"},{"key":"R33-20250709","doi-asserted-by":"crossref","first-page":"7658","DOI":"10.1038\/s41598-022-10746-3","article-title":"Cost-utility analysis on robot-assisted and laparoscopic prostatectomy based on long-term functional outcomes","volume":"12","author":"Lindenberg","year":"2022","journal-title":"Sci Rep"},{"key":"R34-20250709","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s11701-024-02125-z","article-title":"Economic evaluations of robot-assisted radical prostatectomy and the factors affecting its cost-effectiveness: A systematic review","volume":"18","author":"Lei","year":"2024","journal-title":"J Robot Surg"},{"key":"R35-20250709","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s40258-024-00920-1","article-title":"Economic evaluations of robotic-assisted surgery: Methods, challenges and opportunities","volume":"23","author":"Lai","year":"2025","journal-title":"Appl Health Econ Health Policy"},{"key":"R36-20250709","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.athoracsur.2021.06.090","article-title":"Cost-effectiveness analysis of robotic-assisted lobectomy for non-small cell lung cancer","volume":"114","author":"Heiden","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"R37-20250709","doi-asserted-by":"crossref","first-page":"22","DOI":"10.21037\/vats-22-20","article-title":"The price of robotic lobectomy","volume":"8","author":"Lee","year":"2023","journal-title":"Video-assist Thorac Surg"},{"key":"R38-20250709","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1097\/SLA.0000000000006073","article-title":"Robotic lobectomy is cost-effective and provides comparable health utility scores to video-assisted lobectomy: Early results of the RAVAL trial","volume":"278","author":"Patel","year":"2023","journal-title":"Ann Surg"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_174_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:37Z","timestamp":1786647457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_174_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":38,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_174_24","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2024-08-26","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-18","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}