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Mediastinal Lymph Node Dissection During Minimally Invasive Pulmonary Resections: Is Uniportal VATS Good Enough?
Joshua S. Newman1, Stevan S. Pupovac1, Kyle W. Riggs1, Miguel Alexis1, Sridhar Uttara2, Julissa Jurado1, Kevin Hyman1, Paul C. Lee1, David Zeltsman1.
1Northwell Health, New Hyde Park, NY, USA, 2Northwell Health, Manhasset, NY, USA.

OBJECTIVE:
Single-incision VATS offers a most minimally invasive approach to pulmonary resection; however, it is questioned if this approach offers as adequate of a lymph node dissection as alternative modalities including robotic VATS approaches. We demonstrate that single incision VATS allows oncologic resections and staging non-inferior to robotic assisted approaches.
METHODS: We performed a retrospective review comparing robotic-assisted and single-incision VATS lobectomy over 27-months. Inclusion criteria were age 18-90 years at operation and anatomic lobectomy by either robotic assisted or single-incision VATS approaches. Exclusion criteria were incomplete demographic data, benign diagnosis on frozen pathology, and intraoperative conversion to an alternative modality (eg: thoracotomy). Our cohort was propensity matched. The study was approved by the Northwell Health Internal Review Board. (IRB: 21-0738)
RESULTS: Five hundred and twenty-six (n=526) patients met inclusion but not exclusion criteria with a resultant 187 matched pairs. There was no statistically significant difference in average number of lymph nodes sampled between the robotic and single-incision cohorts. (14.7 vs 16.1; p=0.30) Furthermore, the number of lymph node stations sampled was not different between the robotic and single-incision cohorts. (4.62 vs 4.40, p=0.19). (Table I) Length of stay was not statistically significantly different between the robotic and single incision cohorts (p=0.06).
CONCLUSIONS:
VATS is readily utilized for oncologic pulmonary resection. Although concern exists over the ability to perform an adequate lymph node dissection via a most minimally invasive single-incision approach, we suggest this modality offers non-inferior lymph node sampling and staging when compared with a robotic assisted approach.

Table I
Single Incision (n=187)Robotic Assisted (n=187)p-value
Number of Nodes16.129.714.77.2p=0.297
Number of Stations4.401.64.621.4p=0.188


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