Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer

Abstract

Background: The Da Vinci robotic system has been used to enhance the surgeon's visualization and agility in lung cancer surgery, and thus facilitate refined dissection, knot tying and suturing. However, only a few case reports exist on performing a sleeve lobectomy with a robotic-assisted thoracoscopic surgery (RATS) technique. Here we describe our early experience performing RATS sleeve lobectomies. To our knowledge, this is the first study reporting a series of RATS sleeve lobectomies.

Methods: The six consecutive NSCLC patients who underwent a RATS sleeve lobectomy between November 2013 and July 2015 at the National Taiwan University Hospital were enrolled in this study. The lobectomies were all performed by the same surgeon using a three-arm robotic system with an additional utility incision made for assistance and specimen retrieval.

Results: Five patients were diagnosed with squamous cell carcinoma, while the sixth was diagnosed with a carcinoid tumor. The mean operation time was 436.7 [255-745] minutes. The mean postoperative intensive care unit (ICU) stay and hospital stay were 3.7 [1-11] and 11.3 [3-26] days, respectively. Two (33.3%; 2/6) morbidities were noted, including one pneumonia and one anastomosis stricture. There were no cases of mortality or of conversion to thoracotomy.

Conclusions: Our experience performing a RATS sleeve lobectomy in the six patients demonstrated the feasibility of RATS in complex lung cancer surgeries. The three-dimensional vision and articulated joint instruments made robotic-assisted bronchial anastomosis easier under the endoscopic setting. Our experience suggests that RATS offers specific advantages with regard to accuracy and safety when performing sleeve lobectomies.

Keywords: Robotic sugery; lung cancer surgery; sleeve lobectomy.

Figure 1

Bronchial anastomosis during RATS sleeve lobectomy. (A) After left upper lobe sleeve lobectomy, a needle driver was introduced to replace the electrocautery instrument; (B) left lower lobe bronchus and left main bronchus anastomosis was performed with a continuous running suture with 4-0 absorbable monofilament stitches (case 3). RATS, robotic-assisted thoracoscopic surgery.

Figure 2

Pre- and postoperative images of RATS sleeve lobectomy. (A) Preoperative computed tomography imaging illustrating the tumor in the hilum; (B) computed tomography imaging; and (C) bronchoscopy illustrating patent bronchial anastomosis 3 months after surgery (case 3). RATS, robotic-assisted thoracoscopic surgery.