Standardizing Robotically Assisted VATS Lobectomy: Assessing Feasibility and Safety in 128 Consecutive Patients by Multiple Surgeons Across a Single Healthcare System
John F. Lazar1, Laurence N. Spier2, Brian Mitzman1, Gregory Fontana1, Alan Hartman2, Richard Lazzaro1, 1Lenox Hill Hospital, New York, NY, 2North Shore University, Manhasset, NY
OBJECTIVE: The purpose of this study was to show how a standardized robotic technique is both safe and reproducible between surgeons and institutions.
METHODS: From July 1, 2012 to October 1, 2013 patients undergoing RVATS lobectomy for both benign and malignant disease were identified from a prospectively collected database of 2 thoracic surgeons from different hospitals within the same healthcare system and retrospectively analyzed. The primary end points of the study were in-hospital and 30 day mortality. Secondary end points were differences in morbidity and peri-operative outcomes between the two surgeons based on their Rule of 10 s technique.
RESULTS: A total of 128 cases were performed with 121 lobectomies, 3 bilobectomies, and 4 pneumonectomies for both malignant and benign disease. Each surgeon had 64 cases without a single in-hospital or 30 day mortality. There was no statistical difference in length of stay, complications, severity of illness, clinical staging, or number of lymph nodes between the 2 surgeons. Compared to published national meta-analysis on RVAT lobectomies there was reduced length of stay (4.2 vs 6 days), complications (15.6 vs 43.4%), bleeding (0.8 vs 1.8%) and mortality (0 vs 1).
CONCLUSIONS: By standardizing how a robotic lobectomy is performed we were able to show that RVATS lobectomy is safe. We hope these results will help lead to the standardization robotic lobectomy and a larger multi-surgeon/institutional study that could pave the way for greater adoption of minimally invasive lobectomy.