Initial Results of Robotic Surgery for Primary Lung Cancer: Feasibility, Safety and Learning Curve

Abstract

Background At the end of 2016, robot-assisted thoracoscopic surgery (RATS) was still not covered by Japanese national health insurance. Therefore, few institutions in Japan perform RATS and even fewer have reported procedures as they occurred earlier. So, we decided to focus on the initial results of RATS for primary lung cancer. Methods We retrospectively reviewed 44 patients who underwent RATS for primary lung cancer from January 2011 to August 2016. After mastering the initial procedure, we introduced a completely portal robotic pulmonary resection procedure using a carbon dioxide insufflation system. Cases were divided into 2 groups: the early period (20 cases) and the later period (24 cases). Results There was no case of conversion to video-assisted thoracoscopic surgery or thoracotomy. In the 44 cases of primary lung cancer, median operating time was 239.5 min, console time was 179 min, blood loss was 10 mL, drainage period was 2 days, morbidity of Grade 2 or more (Clavien-Dindo classification) was 18.2%, morbidity of Grade 3 or more was only 4.6%, and there was no 30-day mortality. Median operating and console times were significantly shorter in the later period (215 min and 159.5 min, respectively) than in the initial period (300.5 min and 228 min, respectively). Median blood loss was significantly lower in the later period (5 mL) than in the initial period (50 mL). Fiveyear overall and disease-free survival rates were 100% and 88.9%, respectively. Conclusion RATS for primary lung cancer is feasible and safe, has a faster learning curve, and provides satisfactory. Studies with longer follow-ups and larger numbers of cases are necessary.

Starting experience in robotic thoracic surgery

“…In various studies, the investigators reported that the operation time for lobectomy was between 104 and 226 minutes after the learning curve. The same time was 136.9 minutes in our study, which was consistent with the results of the published studies [13][14]. The curve representing the operation time of the first 20 patients showed a statistically significant decline ( Figure 2).…”

Outcomes of major complications after robotic anatomic pulmonary resection

“…15 In regards to the surgeons' prior operative experience, the present study found no differences in the incidence of major postoperative complications for ≤ 20 cases versus > 20 cases, although the former group were associated with longer operative duration, similar to other contemporary reports. 24 Limitations of the present multi-institutional study included its retrospective nature, and the intrinsic potential biases and data heterogeneity associated with this study design. All the participating centers had a prospectively maintained database, and a standardized data form with a data dictionary were formulated after discussion and consensus a priori to centralized data collection.…”

Perioperative outcomes of robot‐assisted vs video‐assisted and traditional open thoracic surgery for lung cancer: A systematic review and network meta‐analysis

“…However, no significant trend in the reduction in the RATS operative times, when comparing the first 10 with the last 10 cases, was observed in Worrell's series 32 . We calculated the learning curve regarding operation time from 13 articles, 24,32,33,49,59,66‐73 and the pooled data indicated that the operative time decreased significantly as the surgeon performed more surgeries (254.9 vs 198.7 min, WMD: 56.95, 95% CI:30.06‐83.83, P < .001; Supporting Information Figure S3). Therefore, it is possible that with the popularization of RATS, RATS would show a comparable operative time with VATS.…”