Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases

Abstract

Background: Minimally invasive surgery (MIS) is becoming the standard of care for anatomic lung resections. The advantages of the uniportal approach compared to the conventional multiple incision approach, multiportal video-assisted thoracic surgery (mVATS) and multiportal robotic-assisted thoracic surgery (mRATS), have been previously described. However, no research studies comparing early outcomes between uniportal video-assisted thoracic surgery (uVATS) and uniportal robotic-assisted thoracic surgery (uRATS) have been reported. Methods: Anatomic lung resections performed by uVATS and uRATS from August 2010 to October 2022 were enrolled. Early outcomes were compared after propensity score-matched (PSM) analysis by applying a multivariable logistic regression model including gender, age, smoking habit, forced expiratory volume in the first second (FEV1), cardiovascular risk factors (CVRF), pleural adhesions and tumor size.Results: A total of 200 patients who underwent anatomic lung resections by the same surgeon were recruited in this study, including the initial 100 uVATS patients and the initial 100 uRATS patients. After PSM analysis, each group included 68 patients. The comparison of the two groups showed no significant differences according to the TNM stage in patients with lung cancer, surgical time, intraoperative complications, conversion, number of nodal stations explored, opioid usage, prolonged air leak, length of intensive care unit (ICU) and hospitalization, reintervention and mortality. However, there were significant differences concerning the histology and type of resection (anatomic segmentectomies, the proportion of complex segmentectomies and the sleeve technique were significantly higher in the uRATS group), number of resected lymph nodes (significantly higher in the uRATS group), postoperative complications and duration of chest drain (significantly lower in the uRATS group).Conclusions: Judging from the short-term outcomes, our results confirm the safety, feasibility and efficacy of uRATS as a new minimally invasive technique that combines the benefits of the uniportal method and robotic systems.

Uniportal fully robotic-assisted major pulmonary resections

“…The median operative time was statistically lower in URATS group (136 vs. 150 min) and the median length of stay was significantly shorter in the URATS group (4 vs. 5 days). Rate of complications and 30-day mortality was low in both groups ( 20 ).…”

The perioperative outcomes of uniportal robotic-assisted thoracic surgeries—a systematic review and meta-analysis of surgical cohort studies and case reports

“…A total of 137 studies on the application of u-RATS were identified for inclusion, with 12 progressing to inclusion (5 cohort series, 7 case reports) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The cohort series are presented in Table 3.…”

“…All 5 included cohort studies (7,8,11,14,15) were deemed to be of low risk of bias, with the primary concern being the lack of control arms and potential for selection bias given strict selection criteria of the patients for the series.…”

“…Reporting of key comorbidities, such as smoking status or past medical history, was universally poor across the included studies, with only one author partially detailing these datapoints (11). Surprisingly, only two of the included studies reported workable information on lymph node clearance, prohibiting meta-analysis, despite this being a fundamental datapoint in establishing the utility of this surgical approach (7,14). Margin clearance was notably also not reported.…”

What's new in thoracic oncology

“…Paradela and colleagues compared U‐RATS with U‐VATS in a group of 200 patients undergoing anatomic lung resections 74 . The authors discovered that U‐VATS was associated with higher rates of intraoperative bleeding (5% vs. 0%) and length of chest tube duration (3.9 days vs. 2.5 days).…”