Surgeon Experience Is Associated With Prolonged Air Leak After Robotic-assisted Pulmonary Lobectomy

Su, Lowell; Ho, Helen; Stock, Cameron; Quadri, Syed M.; Williamson, Christina; Servais, Elliot L.

doi:10.1016/j.athoracsur.2021.07.033

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…Depending on the metric of interest and the degree of initial technical competency with VATS, the learning curve for robotic-assisted lobectomy was identified to be 25.3±12.6 cases. These values encompass acceptable case volumes for subjective surgeon comfort and ease with the robotic system, reflect the point of reduction of operative times towards the ‘plateau’ and ‘mastery’ phases of learning, and complication rates such as postoperative air leaks and transfusion amounts ( 10 ). Unsurprisingly, in those cohorts where surgeons were already considered experts in VATS (without additional quantification of degree of expertise), or when they were the sole robotic operators in an institution, technical proficiency was achieved earlier in the learning process ( 22 , 23 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…CUSUM analysis was utilized for five studies ( 13 , 15 , 18 , 21 , 29 ), whereas other studies report trendline regression (similar in principle to CUSUM) ( 9 ) or plateaus in improvement across specific outcomes ( 10 - 12 , 19 ). To the author’s knowledge, there are no means of aggregating these statistical methods, other than through accepting their individual constraints, and aggregating them as a whole.…”

Section: Discussionmentioning

confidence: 99%

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The learning curve of the robotic-assisted lobectomy—a systematic review and meta-analysis

Wilson-Smith¹,

Anning²,

Muston³

et al. 2023

Ann Cardiothorac Surg

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Background Early studies have illustrated the robotic lobectomy to be safe, oncologically effective, and economically feasible as a therapeutic modality in the treatment of thoracic malignancies. The ‘challenging’ learning curve seemingly associated with the robotic approach, however, continues to be an often-cited factor to its ongoing uptake, with the overwhelming volume of these surgeries being performed in centers of excellence where extensive experience with minimal access surgery is the norm. An exact quantification of this learning curve challenge, however, has not been made, begging the question of whether this is an outdated assumption, versus fact. This systematic review and meta-analysis sort to clarify the learning curve for robotic-assisted lobectomy based on the existing literature. Methods An electronic search of four databases was performed to identify relevant studies outlining the learning curve of robotic lobectomy. The primary endpoint was a clear definition of operator learning (e.g., cumulative sum chart, linear regression, outcome-specific analysis, etc.) which could be subsequently aggregated or reported. Secondary endpoints of interest included post-operative outcomes and complication rates. A meta-analysis using a random effects model of proportions or means was applied, as appropriate. Results The search strategy identified twenty-two studies relevant for inclusion. A total of 3,246 patients (30% male) receiving robotic-assisted thoracic surgery (RATS) were identified. The mean age of the cohort was 65.3±5.0 years. Mean operative, console and dock time was 190.5±53.8, 125.8±33.9 and 10.2±4.0 minutes, respectively. Length of hospital stay was 6.1±4.6 days. Technical proficiency with the robotic-assisted lobectomy was achieved at a mean of 25.3±12.6 cases. Conclusions The robotic-assisted lobectomy has been illustrated to have a reasonable learning curve profile based on the existing literature. Current evidence on the oncologic efficacy and purported benefits of the robotic approach will be bolstered by the results of upcoming randomized trials, which will be critical in supporting RATS uptake.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The learning curve of the robotic-assisted lobectomy—a systematic review and meta-analysis

Wilson-Smith¹,

Anning²,

Muston³

et al. 2023

Ann Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…This analysis showed a significant 15% reduction in PAL onset every 10 additional cases performed (OR =0.85, P=0.04), which became even more evident for the operators with an experience of more than 50 cases behind. This stems from the greater confidence with the robotic system that enabled them to overcome the absence of tactile feedback when manipulating the pulmonary parenchyma and during dissection (20). Therefore, a definitive evaluation on the role of learning curve on the incidence of PAL is challenging.…”

Section: Incidence and Predictive Factors Of Pal In Patients Treated ...mentioning

confidence: 99%

“…The evaluation of other potential risk factors for PAL after robotic lung resection related to patient's characteristics, including male gender, older age, low spirometry values indicative for emphysematous disease, and BMI, showed contrasting results (20,21).…”

Section: Incidence and Predictive Factors Of Pal In Patients Treated ...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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“…While the excellent visualization and the 3-dimensional depth perception provided by the camera reduce this limitation, retracting or grasping lung tissue during robotic surgery can result in unintended trauma of fragile structures such as pulmonary artery branches or the airway wall, in addition to the lung parenchyma itself. In fact, a recent study by Su et al showed a correlation between prolonged post-operative air leak and the accrued experience of robotic surgeons (8). It is common in our current practice to hold the sponge with robotic forceps to push or pull on the lung parenchyma, and to minimize grasping of tissue that will not eventually be resected.…”

mentioning

confidence: 99%

Adopting the robotic platform for anatomic lung resections: real life lessons for the tech enthusiast

Bakhos¹,

Petrov²,

Abbas³

2023

J Thorac Dis

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Surgeon Experience Is Associated With Prolonged Air Leak After Robotic-assisted Pulmonary Lobectomy

Cited by 9 publications

References 27 publications

The learning curve of the robotic-assisted lobectomy—a systematic review and meta-analysis

The learning curve of the robotic-assisted lobectomy—a systematic review and meta-analysis

Prolonged air leak after robotic lung resection: a narrative review

Adopting the robotic platform for anatomic lung resections: real life lessons for the tech enthusiast

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