Robotic Lung Resection for Non–Small Cell Lung Cancer

Wei, Benjamin; Eldaif, Shady M.; Cerfolio, Robert J.

doi:10.1016/j.soc.2016.02.006

Cited by 21 publications

(10 citation statements)

References 20 publications

(20 reference statements)

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“…These results have been reproduced by several other groups demonstrating improved outcomes with the use of segmentectomy. [27][28][29][30] The greater precision afforded by the robotic approach compared with thoracoscopic approach has fueled interest in comparative studies to formally evaluate the two techniques particularly in light of the increased resource allocation necessary in the establishment of a robotic program. [31][32][33][34] Results have unsurprisingly confirmed increased costs involved in the establishment of the latter.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Musgrove

Hayanga

Holmes

et al. 2018

Innovations�(Phila)

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Objective Pulmonary segmentectomy using robotic assistance is often perceived as being more expensive than segmentectomy using video-assisted thoracic surgery. The robotic technique allows for meticulous dissection during segmentectomy, potentially leading to fewer parenchymal injuries, fewer air leaks, and shorter length of stay. This study compared pulmonary segmentectomy costs using video-assisted thoracic surgery versus robotic with manual staplers versus robotic with robotic staplers. Methods Retrospective analyses were performed evaluating our early experience with robotic pulmonary segmentectomy for 30 months compared with the video-assisted thoracic surgery approach. All 50 anatomical segmentectomies performed since introduction of robotic technique in the practice were included. Twenty-eight procedures were robotic-assisted and 22 were video-assisted thoracic surgery. Procedure-specific evaluation of direct costs was performed, including cost of robotic instruments, staplers, and average length of stay in the hospital. Results The mean ± SD age was 70 ± 10 years (range = 43–91 years). There were 12 males in the robotic group and eight in the video-assisted thoracic surgery group ( P = 0.642). The mean age was 69 years in the robotic group and 71 years in the video-assisted thoracic surgery group ( P = 0.367). The median length of stay was 2 (2–4) days in the robotic group (range = 1–9) and 4 (2–5) days in the video-assisted thoracic surgery group (range = 1–20, P = 0.089). The cost of robotic segmentectomy with manual staplers was less than that with robotic staplers. Both robotic techniques cost less than video-assisted thoracic surgery. Conclusions In this small series, cost and outcomes in our early experience with robotic-assisted segmentectomy were comparable with our video-assisted thoracic surgery approach with trends toward shorter length of stay and fewer complications. Larger series are needed to validate these results.

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Section: Discussionmentioning

confidence: 99%

Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Musgrove

Hayanga

Holmes

et al. 2018

Innovations�(Phila)

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“…Over the latest years, papers have focused the attention on lymphadenectomy and nodal upstaging in order to evaluate the quality of minimally invasive surgery (MIS), compared to open surgery in the treatment of lung cancer. Video-assisted thoracic surgery and the most innovative robotic surgery are associated with better postoperative results, in terms of length of stay, rate of complications and quality of life [10,11] .…”

Section: Nodal Upstaging In Nsclcmentioning

confidence: 99%

Nodal upstaging robotic lobectomy for non-small cell lung cancer

Zirafa¹,

Romano²,

Nesti³

et al. 2020

MIS

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Nodal upstaging takes place when unsuspected lymph node metastases are detected by pathological evaluation, after surgical treatment for non-small cell lung cancer. In early stages non-small cell lung cancer, nodal upstaging amounts to 4.8%-24.6%, depending on several factors, such as accuracy of preoperative staging, localisation and size of tumour and number of lymph nodes removed. Nodal upstaging is considered a surrogate of the completeness of thoracic oncologic surgery; for this reason, various studies focus on the evaluation of its rate in the different surgical approaches used to treat lung cancer. In this analysis, a high percentage of upstaging is observed in robotic surgery, having similar values to open surgery results, usually considered the gold standard in terms of oncologic radicality. In fact, thanks to its features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and manoeuvrability of the instruments even in the most remote areas of the thorax. According to these results, robotic surgery constitutes a safe and radical surgical option, showing encouraging results on the efficacy of lymphadenectomy and, consequently, on its the long-term outcomes.

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“…Various authors have reported the need of 18-20 robot-assisted lobectomies performed with the da Vinci apparatus for an experienced thoracic surgeon to complete the learning curve. 3,4,[11][12][13][14][15] Thus, compared with VATS lobectomy, robotassisted surgery initially seems to require a shorter learning phase. However, a comparative study by Veronesi et al 16 on the RATS and VATS learning curves of 2 surgeons from the same institution and with the same thoracotomy experience found there were 2 phases with RATS: an initial decrease of operative time from 220 to 190 minutes after the first 15 procedures, and a second reduction to 150 minutes after the first 90; in contrast, the duration was reduced after 30 cases for VATS.…”

Section: Closing Remarksmentioning

confidence: 99%

Robotic Lobectomy: Right Upper Lobectomy

Veronesi

Novellis

Bottoni

et al. 2016

Operative Techniques in Thoracic and Cardiovascular Surgery

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Evidence favors a minimally invasive approach for early-stage lung cancer. Video-assisted thoracoscopy is the technique most commonly used today, but the robotic approach is considered the future of minimally invasive surgery, above all because of its high-definition stereoscopic view, improved dexterity because of increased degrees of movement of the instruments, lack of the fulcrum effect, tremor filtration, and greater surgeon comfort. Two techniques have been described for robotic lobectomy: robotic-assisted thoracoscopic surgery (RATS) and complete portal robotic lobectomy. The RATS technique necessitates an anterior approach to the hilum and does not routinely use CO2 insufflation; complete portal robotic lobectomy uses a posterior approach, with the specimen extracted at the end of surgery via a subcostal, transdiaphragmatic route. This article provides a step-by-step description of right upper lobectomy using a 4-arm RATS approach. The procedure is feasible and safe to perform for experienced surgeons. Although the incidence of severe intraoperative complications is low but potentially life-threatening, we believe the technique is valid for the minimally invasive treatment of lung cancer. Nonetheless, operator comfort should be the main factor influencing the choice of technique.

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Robotic Lung Resection for Non–Small Cell Lung Cancer

Cited by 21 publications

References 20 publications

Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Nodal upstaging robotic lobectomy for non-small cell lung cancer

Robotic Lobectomy: Right Upper Lobectomy

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