Eastern Cardiothoracic Surgical Society

Effect of Small Body Habitus on Peri-Operative Outcomes after Robotic-Assisted Pulmonary Lobectomy: Retrospective Analysis of 200 Consecutive Patients
Frank O. Velez-Cubian1, Wei Wei Zhang1, Kathryn Rodriguez1, Matthew R. Thau1, Jacques-Pierre Fontaine2, Joseph R. Garrett2, Carla C. Moodie2, Lary A. Robinson2, Eric M. Toloza2, 1University of South Florida College of Medicine, Tampa, FL, 2Moffitt Cancer Center, Tampa, FL

OBJECTIVE: Patients with smaller body surface area (BSA) have smaller pleural spaces, which limit visualization and instrument mobility during video-assisted thoracoscopic (VATS) surgery. We investigated the effects of BSA on outcomes with robotic-assisted VATS lobectomy.

METHODS: We retrospectively analyzed 200 consecutive patients who underwent robotic-assisted lobectomy by one surgeon over 32 months. Patients were separated into Group A (BSA<1.65m2) and Group B (BSA>1.65m2). Operative times, estimated blood loss (EBL), conversion to open lobectomy, perioperative complication rates, chest tube days, hospital length of stays (LOS), and in-hospital mortality were compared between the two groups.

RESULTS: Group A had 39 patients (BSA 1.25m2-1.65m2) and Group B had 161 patients (BSA range 1.66-2.86m2). Both groups had similar prolonged air leak rates (15% vs. 17%; p=1.0), median chest tube duration of 4 days, and median hospital LOS of 5 days. See Table for other outcomes results.

CONCLUSIONS: While patients with BSA<1.65m2 have similar operative times, EBL, overall intraoperative complications, overall postoperative complications (such as atrial fibrillation, prolonged air leaks, and pneumonia), chest tube days, hospital LOS, and in-hospital mortality rates as patients with larger BSA, patients with BSA<1.65m2 have a higher overall conversion rate than, but similar emergent conversion rate as, patients with larger BSA. Thus, our study suggests that robotic-assisted pulmonary lobectomy is feasible and safe in patients with small body habitus, although these patients require better preoperative selection to avoid non-emergent conversion to open lobectomy.

Effect of BSA on Perioperative Outcomes after Robotic-Assisted Pulmonary Lobectomy

Perioperative Outcome Group A,
N=39
Group B,
N=161
p-value,
significant
at p<0.05
Median Skin-to-Skin Operative Time (min+SEM) 168 + 16 178 + 7 0.45
Median EBL (mL+SEM) 150 + 90 175 + 40 0.60
Overall Intra-Operative Complications (n, %) 5 (13%) 12 (7%) 0.33
Overall Conversion to Open Lobectomy (n,%) 8 (21%) 13 (8%) 0.04
Emergent Conversion to Open Lobectomy (n,%) 2 (5%) 4 (2%) 0.33
Atrial Fibrillation (n,%) 2 (5%) 21 (13%) 0.26
Mucus Plugs Requiring Intervention (n,%) 1 (3%) 13 (8%) 0.31
Pneumonia (n,%) 2 (5%) 21 (13%) 0.26
In-Hospital Mortality (n,%) 0 (0%) 5 (3%) 0.58