Robotic-assisted Versus Video-assisted Thoracoscopic Lobectomy

Abstract

Objective: To determine whether RAL affects perioperative outcomes and long-term efficacy in NSCLC patients, compared with traditional VAL. Summary of Background Data: RAL is a promising treatment for NSCLC. However, its efficacy has not been fully evaluated. Methods: A single-center, open-labeled prospective randomized clinical trial was launched in May 2017 to compare the efficacy of RAL and VAL. By May 2020, 320 patients were enrolled. The perioperative results of RAL and VAL were compared. Results: The 320 enrolled patients were randomly assigned to the RAL group (n ¼ 157) and the VAL group (n ¼ 163). Perioperative outcomes were comparable between the 2 groups, including the length of hospital stay (P ¼ 0.76) and the rate of postoperative complications (P ¼ 0.45). No perioperative mortality occurred in either group. The total amount of chest tube drainage {830 mL [interquartile range (IQR), 550-1130 mL] vs 685 mL [IQR, 367.5-1160 mL], P ¼ 0.

Uniportal robotic‐assisted thoracoscopic surgery for early‐stage lung cancer with the Da Vinci Xi: Initial experience of two cases

“…Advantages of RATS should not be listed as only technical; indeed the most recent meta‐analysis comparing the different surgical approaches in the treatment of NSCLC (open thoracotomy, VATS and M‐RATS) have already reported the association between M‐RATS and decreased postoperative morbidity and mortality rates, shorter length of stay, faster recovery, higher number of harvested lymph nodes and similar, if not improved, conversion rate to thoracotomy, overall patient survival and disease‐free survival 3,4,7–13,17 …”

“…Indeed, thanks to its peculiar features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and maneuverability of the instruments even in the most remote areas of the thorax, leading to a more accurate staging and hence patient prognosis 9–11,17,26 …”

“…On the other hand, utilisation of markedly expensive equipment and consequently major procedural costs of RATS represent the main controversies surrounding the methodic, 6,11,17 though recent data have suggested similar expenses of RATS compared to VATS and open thoracotomy at high volume centres 14 …”

“…Indeed, several reviews, meta‐analysis and randomised controlled trials comparing the two methods, have already demonstrated the safety and feasibility of multiportal RATS (M‐RATS), 3–5,7–17 that is, the surgical technique accomplished through three or four incisions for port placement, with the most recent studies reporting lower postoperative morbidity and mortality rates, shorter length of stay, faster recovery, higher number of harvested lymph nodes and similar, if not improved, conversion rate to thoracotomy, overall patient survival and disease‐free survival 3,4,7–13,17 …”

“…Main drawbacks of robotic surgical procedures are still represented by longer operative times and major procedural costs 3–5,9–11,17 ; however, while improving surgical proficiency and experience might overcome the first issue in a near future, decreased postoperative complications, and consequent shorter hospitalisation times could compensate the second, particularly at high‐volume centres 14,18 …”