Learning Curve of Robotic Lobectomy for Early-Stage Non-Small Cell                     Lung Cancer by a Thoracic Surgeon Adept in Open Lobectomy

Gallagher, Shea; Abolhoda, Amir; Kirkpatrick, Vincent; Saffarzadeh, Areo; Thein, May S; Wilson, Samuel E.

doi:10.1097/imi.0000000000000552

Cited by 13 publications

(13 citation statements)

References 18 publications

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“…Following review of the title and abstract, 863 studies were excluded and a full text review was performed on the remaining 47 articles. Twenty-two studies reporting on a total of 104,472 patients who underwent either RVATS ( n = 12,061) or open thoracotomy ( n = 92,411) lung resection met the selection criteria [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. A summary of the study selection process is shown in Figure 1 as a PRISMA flowchart.…”

Section: Resultsmentioning

confidence: 99%

“…A key disadvantage of RVATS has been its lengthier operative times, a finding reflected in this meta-analysis. The proponents of the robotic platform have suggested that this may partially reflect the initial learning curve, and several studies have shown reductions in operative times with increased volume over time [ 18 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“… Mortality outcomes in patients who underwent robotic video-assisted thoracoscopic surgery compared with open thoracotomy for resectable non-small cell lung cancer [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 16 , 17 , 18 , 20 , 22 , 23 , 26 , 27 ]. …”

Section: Figurementioning

confidence: 99%

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Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

Zhang

Alzul

Carelli

et al. 2022

JPM

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(1) Background: Conventional open thoracotomy has been the accepted surgical treatment for resectable non-small cell lung cancer. However, newer, minimally invasive approaches, such as robotic surgery, have demonstrated similar safety and efficacy with potentially superior peri-operative outcomes. The present study aimed to quantitatively assess these outcomes through a meta-analysis. (2) Methods: A systematic review was performed using electronic databases to identify all of the relevant studies that compared robotic surgery with open thoracotomy for non-small cell lung cancer. Pooled data on the peri-operative outcomes were then meta-analyzed. (3) Results: Twenty-two studies involving 12,061 patients who underwent robotic lung resection and 92,411 patients who underwent open thoracotomy were included for analysis. Mortality rates and length of hospital stay were significantly lower in patients who underwent robotic resection. Compared to open thoracotomy, robotic surgery was also associated with significantly lower rates of overall complications, including atrial arrhythmia, post-operative blood transfusions, pneumonia and atelectasis. However, the operative times were significantly longer with robotic lung resection. (4) Conclusions: The present meta-analysis demonstrated superior post-operative morbidity and mortality outcomes with robotic lung resection compared to open thoracotomy for non-small cell lung cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

Zhang

Alzul

Carelli

et al. 2022

JPM

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“…There was no statistically significant difference between the learning curve group and the latter group in respect of conversion rates. The published studies showed that conversion rates declined in the learning curve and the latter groups [15,16,23]. Apparently, the relatively small number of the cases in the latter group was not adequate for an evaluation of the conversion rate.…”

Section: Discussionmentioning

confidence: 98%

Starting experience in robotic thoracic surgery

Akkuş¹

2019

Curr Thorac Surg

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Background: The robotic assisted thoracoscopic surgery (RATS) spreads rapidly across the whole world. In this paper, the objective was to present the training experience on RATS in our clinic along with the literature. Materials and Methods: Sixty-three consecutive patients, who had undergone RATS between February 2014 and December 2018, were included in this retrospective non-randomized study. The training period was designed as three phases. Twelve patients with solid and cystic mass lesions in the mediastinum and chest wall were included in group Phase 1. The group Phase 2 consisted of 16 patients who had thymoma and benign pulmonary mass lesions, and 35 consecutive patients were enrolled into group Phase 3 group who had undergone lobectomy. Results: The patients in all groups were compared in respect of the preoperative, perioperative and postoperative results. The docking time was significantly shorter in Phase 3 patients compared to the groups Phase 1 and 2 (p < 0.05). In the lobectomy group (Phase 3), as the console time and operation time was significantly shorter after the 20th patient than the prior patients, first 20 patients were accepted as the learning curve (p < 0.05). In the lobectomy group, in three patients the operation was converted to open surgery during the perioperative period (4.7%). No mortality was observed during the 30-day follow-up. One patient died in the 6 th month of the long-term follow-up. The mean follow-up duration was 28.4 months. Conclusions: RATS is a safe, feasible, and minimally invasive method, which has low complication rates with a satisfying and short learning curve.

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“…Collectively, these studies have identified the performance of approximately 20 lobectomies (range: 15-60) as a marker for technical facility with the robotic platform (20)(21)(22)(23)(24)(25)(26)(27). In one of the more statistically rigorous determinations of this learning curve, Arnold et al utilized a cumulative sum (CUSUM) analysis of operating time to identify a 22-case learning curve with mastery achieved after 63 cases (28).…”

Section: Learning Robotic Thoracic Surgerymentioning

confidence: 99%

Training residents in robotic thoracic surgery

et al. 2021

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With growing integration of robotic technology in thoracic surgery, the need for structured training has never been greater with trainees expressing desire for additional experience. Determining the ideal education program is challenging as the collective experience is still relatively early and growing with many experienced surgeons still becoming facile with the platform. Understanding differences between robotic and thoracoscopic approaches including lung retraction and dissection, use of carbon dioxide insufflation, and lack of tactile feedback serves as the foundation for building a skillset. Currently, there is no standard accepted curriculum for residents. Inclusion of these trainees in structured programs has been shown to be safe with equivalent patient outcomes. There are multiple curricula under development, all of which incorporate use of simulation technology, dual console, and clear, graduated responsibilities within operations. These include introduction to the robotic system prior to progressing to bedside assistance and finally to time as console surgeon. The importance of clear definition of training milestones with deliberate graduation to more complex tasks once competency has been demonstrated cannot be overstated. It is crucial for surgeons practicing robotic surgery to make efforts to further the training of residents, but there has not been any perfect and suitable program identified yet.

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Learning Curve of Robotic Lobectomy for Early-Stage Non-Small Cell Lung Cancer by a Thoracic Surgeon Adept in Open Lobectomy

Cited by 13 publications

References 18 publications

Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

Starting experience in robotic thoracic surgery

Training residents in robotic thoracic surgery

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