Early Experience With Robotic Lung Resection Results in Similar Operative Outcomes and Morbidity When Compared With Matched Video-Assisted Thoracoscopic Surgery Cases

• Published in: The Annals of thoracic surgery Vol. 93; no. 5; pp. 1598 - 1605
• Main Authors: Louie, Brian E., MD, Farivar, Alexander S., MD, Aye, Ralph W., MD, Vallières, Eric, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cardiology. Vascular system; Cardiothoracic Surgery; Case-Control Studies; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Length of Stay; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Pain, Postoperative - physiopathology; Pneumology; Pneumonectomy - methods; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Reference Values; Retrospective Studies; Risk Assessment; Robotics - methods; Statistics, Nonparametric; Surgery; Survival Rate; Thoracic Surgery, Video-Assisted - methods; Thoracic Surgery, Video-Assisted - mortality; 10; Endoscopic surgery; Prognosis; Lung; Surgical resection; Video recording; Morbidity; Robotics; Result; Case study; Experience; Treatment; Anesthesia; Early; Circulatory system; Cardiology; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.01.067

Background Robotic lung resection is gaining popularity despite limited published evidence. Comparative studies are needed to provide information about the safety and effectiveness of robotic resection. Therefore, we compared our initial experience with robotic anatomic resection to our most recent video-assisted thoracoscopic surgery (VATS) cases. Methods A case-control analysis of consecutive anatomic lung resections by robot or VATS from 2009 through 2011 was performed. Results In the robotic group, 52 resections were attempted. Three conversions and 3 wedges were excluded, leaving 40 lobectomies, 5 segments, and 1 conversion to VATS. In the VATS group, 35 resections were attempted with 1 conversion. The distribution of resected lobes or segments and demographics was similar. Clinical outcomes between robotics and VATS were similar in tumor size (2.8 versus 2.3 cm), operative time (213 versus 208 minutes), blood loss (153 versus 134 mL), intensive care unit stay (0.9 versus 0.6 days), and length of stay (4.0 versus 4.5 days). There was no operative mortality. Major (n = 8; 17%) and minor morbidity (n = 12; 26%) with robotics was similar to VATS. The percentage of expected nodal stations sampled was similar. The duration of narcotic use after discharge ( p = 0.039) and the time to return to usual activities ( p = 0.001) was shorter in the robotic group. Conclusions Early experience with robotic resection resulted in similar outcomes compared with mature VATS cases. A potential benefit of robotics may relate to postoperative pain reduction and earlier return to usual activities. Robotic lung resection should be studied further in selected centers and compared with VATS in a randomized fashion to better define its potential advantages and disadvantages.