Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety?

Abstract

Background Minimally invasive surgery has been recently recommended for treatment of early-stage non-small cell lung cancer. Despite the recent increase of robotic surgery, the place and potential advantages of the robot in thoracic surgery has not been well defined until now. Methods We reviewed our prospective database for retrospective comparison of our first 28 video-assisted thoracoscopic surgery lobectomies (V group) and our first 28 robotic lobectomies (R group). Results No significant difference was shown in median operative time between the two groups (185 vs. 190 minutes, p = 0.56). Median preincision time was significantly longer in the R group (80 vs. 60 minutes, P < 0.0001). The rate of emergency conversion for uncontrolled bleeding was lower in the R group (one vs. four). Median length of stay was comparable (6 days in the R group vs. 7 days in the V group, p = 0.4) with no significant difference in the rate of postoperative complications (eight Grade I in both groups, four Grade III or IV in the V group vs. six in the R group, according to the Clavien-Dindo classification, p = 0.93). No postoperative cardiac morbidity was observed in the R group. Median drainage time was similar (5 days, p = 0.78), with a rate of prolonged air leak slightly higher in the R group (25 vs. 17.8%, p = 0.74). Conclusion Perioperative outcomes are similar even in the learning period but robotic approach seems to offer more operative safety with fewer conversions for uncontrolled bleeding.

Robotic lobectomy has the greatest benefit in patients with marginal pulmonary function

“…Our results confirm this finding, and show that the benefit of robotic approach is greatest for high-risk patients. High-risk patients are likely underrepresented in many current robotic lobectomy series, as surgeons may tend to select more straightforward cases when adopting new techniques [ 13 ]. One common concern has been the risk of postoperative air leak with a robotic approach, due to the lack of tactile feedback when manipulation diseased lungs, as well as the need for more dissection in the fissure, which could lead to increased risk of air leak.…”

Report on First International Workshop on Robotic Surgery in Thoracic Oncology

“…A smaller 2015 comparison ( 29 ) of the first 28 VATS lobectomies with the first 28 robotic lobectomies performed in a single institution reported that perioperative outcomes were similar for both techniques during the learning period but that the robotic approach was associated with better safety and fewer conversions for uncontrolled bleeding.…”

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

“…In the last decade, RATS have been amply proven in its feasibility and safety ( 3 , 4 ). Although VATS has been found as being better than open thoracotomy in terms of its lesser invasiveness ( 5 , 6 ), and RATS is associated with a shorter hospital stay and fewer postoperative complications than thoracotomy ( 7 ), RATS requires fewer emergency conversions to open thoracotomy and is associated with lower mortality compared with VATS ( 1 , 8 ).…”