Robotic Surgery and Anatomic Segmentectomy: An Analysis of Trends, Patient Selection, and Outcomes

Zhou, Nicolas; Corsini, Erin M.; Antonoff, Mara B.; Hofstetter, Wayne L.; Mehran, Reza J.; Rajaram, Ravi; Roth, Jack A.; Sepesi, Boris; Swisher, Stephen G.; Vaporciyan, Ara A.; Walsh, Garrett L.; Rice, David C.

doi:10.1016/j.athoracsur.2021.03.068

Cited by 20 publications

(28 citation statements)

References 26 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%

“…In contrast to the previous studies, this present meta-analysis has shown a significant reduction in atrial arrhythmia and a significant increase in the number of lymph nodes stations harvested in the RVATS group compared to open thoracotomy. This may be attributed to the dexterity advantages of robotic instruments in tight spaces, that have been previously hypothesized to contribute to a higher rate of lymph node dissection and reduced tissue trauma [ 9 , 20 ]. A key disadvantage of RVATS has been its lengthier operative times, a finding reflected in this meta-analysis.…”

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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“…The spread of robotic surgery programs led to an increase in the number of sublobar anatomical resections in patients affected by limited disease, in particular among surgeons who completed the learning curve (32). A recent study by Zhou and colleagues compared the perioperative o u t c o m e s o f R AT S , VAT S a n d o p e n a n a t o m i c a l segmentectomies for the treatment of limited NSCLC (33). During the study period, still about half of the cases were approached by thoracotomy, but robotic surgery became the preferred technique at this center in recent years.…”

Section: Mis Techniques Confirmed Substantial Advantages In Terms Of ...mentioning

confidence: 99%

Prolonged air leak after robotic lung resection: a narrative review

Muriana¹,

Rossetti²,

Viscardi³

et al. 2023

J Thorac Dis

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Background and Objective: Prolonged air leak (PAL) following lung resection is related to an increase in morbidity and both direct and indirect costs. In recent years, robotic-assisted thoracic surgery (RATS) has proved to be a safe technique with comparable perioperative outcomes of video-assisted thoracic surgery (VATS), optimal oncological results, and potential advantages in case of sublobar resection. We here focus on the incidence and clinical impact of PAL in the field of robotic surgery and discuss the therapeutic strategies currently available.Methods: We conducted a search on PubMed/MEDLINE and Scopus database from inception until May 27 th 2022 to select the relevant literature published in English exploring the occurrence of PAL following RATS.

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“…For example, Zhou and colleagues reported an increase in segmentectomy at their center over time, and particularly an increased use of the robot for complex segmentectomies. Despite the complex cases, the robotic approach was associated with low perioperative morbidity and mortality, and there were no conversions to open (27).…”

Section: Introductionmentioning

confidence: 99%

Robotic upper lobe segmentectomy: technical pearls

Nawalaniec¹,

Auchincloss²,

Schumacher³

2023

J Vis Surg

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Minimally invasive approaches to segmentectomy have grown in popularity as sublobar resection has been increasingly offered as a parenchyma-sparing alternative to lobectomy for amenable lesions. Both video-assisted thoracic surgery and robotic surgery offer advantages over traditional thoracotomy, with fewer complications, shortened hospital stay, and less pain. While segmentectomy has been traditionally performed by video-assisted thoracic surgery, the robotic approach represents a growing subset of minimally invasive sublobar resections. Patient selection for robotic segmentectomy involves a standard preoperative evaluation including pulmonary function tests, cardiac evaluation, and complete staging. Preoperative axial imaging is essential in choosing patients with lesions amenable to segmentectomy, and evaluating the segmental anatomy. Safe robotic segmentectomy centers around thorough knowledge of the segmental vascular and bronchial anatomy and its variants, and preoperative imaging can help the surgeon anticipate variant anatomy intraoperatively. The operative technique generally involves a mediastinal lymph node dissection with frozen section of the N1 nodes and conversion to lobectomy if positive. The segmental resection then proceeds depending on the individual segment to be resected, but generally involves dissection and division of the vessels and bronchus, followed by division of the parenchyma along the intersegmental plane. For most patients, postoperative recovery is short and uncomplicated, with most patients being discharged on the first or second postoperative day.

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Robotic Surgery and Anatomic Segmentectomy: An Analysis of Trends, Patient Selection, and Outcomes

Cited by 20 publications

References 26 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

Prolonged air leak after robotic lung resection: a narrative review

Robotic upper lobe segmentectomy: technical pearls

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