Eastern Cardiothoracic Surgical Society

The Role of the Surgical Robot in an Advanced VATS Program
Chukwumere Nwogu1, Miriam Huang1, Winston Wong2, Sai Yendamuri1, Elisabeth Dexter1, Mark Hennon1, Anthony Picone1, Todd Demmy1, 1Roswell Park Cancer Institute, Buffalo, NY, 2State University of New York At Buffalo, Buffalo, NY

OBJECTIVE : An ever-increasing proportion of thoracic procedures are being performed using minimally invasive techniques. Whether use of the Da Vinci surgical robot provides any additional benefits beyond conventional thoracoscopic techniques remains controversial. Given our prior establishment of an advanced VATS program, we reviewed our initial robot-assisted surgical experience with a focus on lobectomies as a prelude to a prospective comparison study.

METHODS: We conducted a retrospective review of all robot-assisted procedures performed at our institution from August 2005 to July 2013. Types of procedures were categorized as shown in Table 1. For ease of outcomes assessment, we focused on lobectomies. Outcome data collected included conversion rates to open procedures, mortality, operative times, blood loss, chest tube duration, length of hospital and ICU stay.

RESULTS: The procedures performed and the conversion rates are shown in Table1. Intension-to-treat analysis of the lobectomy series yielded the following outcomes: no mortality, mean operative time 285 minutes (range 177-437); median blood loss 150 ml(range 10-1000); median chest tube duration 2.5 days (range 1-12); median ICU length of stay 1 day (range 0-3) and median hospital length of stay 3.5 days (range 2-12).

CONCLUSIONS: Progressive incorporation of surgical robot-assistance into an advanced thoracoscopic program is feasible. The outcomes of robot assisted thoracoscopic (RATS) lobectomy are similar to reported outcomes of VATS lobectomy. Prospective comparison of these 2 procedures would provide greater understanding of the precise benefits or lack thereof of the Da Vinci surgical robot system for minimally invasive thoracic surgery.

Categories and conversion rates of robot assisted procedures performed

Procedure Categories Number of Cases Number converted to open cases (%)
Lobectomies 22 3 (14)
Pulmonary Wedge
Resections
6 1 (17)
Esophagectomies 18 8 (44)
Benign
Esophageal Disorders
7 1 (14)
Mediastinal
lesion resections
11 1 (9)
Total 64 14 (22)