Early adoption of robotic lung resection in an established video assisted thoracic surgery practice

• Published in: Surgery open science Vol. 20; pp. 189 - 193
• Main Authors: Deeb, Ashley L., De Leon, Luis, Mazzola, Emanuele, Kucukak, Suden, Singh, Anupama, McAllister, Miles, Garrity, Matthew, Jaklitsch, Michael T., Wee, Jon O., Rochefort, Matthew M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2024; Elsevier
• Subjects: Lung resection; Research Paper; Robotic-assisted thoracic surgery; VATS; Lung resection; VATS; Robotic-assisted thoracic surgery
• ISSN: 2589-8450; 2589-8450
• DOI: 10.1016/j.sopen.2024.07.004

Reported advantages to robotic thoracic surgery include shorter length of stay (LOS), improved lymphadenectomy, and decreased complications. It is uncertain if these benefits occur when introducing robotics into a well-established video-assisted thoracoscopy (VATS) practice. We compared the two approaches to investigate these advantages.
IRB approval was obtained for this project. Patients who underwent segmentectomy or lobectomy from May 2016–December 2018 were propensity-matched 2: 1 (VATS: robotic) and compared using weighted logistic regression with age, gender, Charlson Comorbidity Index, surgery type, stage, Exparel, and epidural as covariates. Complication rates, operation times, number of sampled lymph nodes, pain level, disposition, and LOS were compared using Wilcoxon rank-sum and with Rao-Scott Chi-squared tests.
213 patients (142 VATS and 71 robot) were matched. Duration of robotic cases was longer than VATS (median 186 min (IQR 78) vs. 164 min (IQR 78.75); p < 0.001). Significantly more lymph nodes (median 11 (IQR 7.50) vs. 8 (IQR 7.00); p = 0.004) and stations were sampled (median 4 (IQR 2.00) vs. 3 (IQR 1.00); p < 0.001) with the robot. Interestingly, robotic resections had higher 72-hour pain scores (median 3 (IQR 3.25) vs. 2 (IQR 3.50); p = 0.04) and 48-hour opioid usage (median 37.50 morphine milligram equivalents (MME) (IQR 45.50) vs. 22.50 MME (IQR 37.50); p = 0.01). Morbidity, LOS, and disposition were similar (all p > 0.05).
The robotic approach facilitates better lymph node sampling, even in an established VATS practice.
•Benefits of robotic surgery are seen even in well-established VATS practice.•Robotic-assisted lung resection results in better lymph node sampling.•Patients with robotic resection had higher 72-hour pain scores and 48-hour narcotic use.•Morbidity and length of stay were equivalent between the two approaches.