Robotic lobectomy: flattening the learning curve

Abstract

Early experience with robotic technology in pulmonary resection has emphasized a steep learning curve. We initiated a robotic thoracic surgical program with the goal of minimizing complications, operative times, and hospital stays. We implemented robotic lobe resections at our institution with the intent of performing an operationally analogous procedure to that of the open technique. Specifically, we used single docking of the robotic cart, innovative retraction, single interspace port placement, and dockings specific to the resected lobe. We reviewed outcomes for patients undergoing robotic lobectomy at our institution. Data is presented as mean ± standard deviation. 20 patients (69 ± 12 years) underwent robotic lobe resections. American Joint Committee on Cancer staging for 14 patients undergoing resections for non-small cell lung cancers were Stage I (10), Stage II (2), and Stage III (2). Operative times for 20 patients undergoing robotic lobectomies were 203 ± 53 min. Median postoperative hospital stay was 3 days. Conversions to open procedures were required in two patients secondary to failure to progress (1) and bleeding (1). Complications occurred in four (20%) patients and included atelectasis (2), myocardial infarction (1), and atrial fibrillation (1). No fatalities occurred. The perception that robotic pulmonary resection involves a steep learning curve may not be universally accurate; our operative times and hospital stays are consistent with those reported by established programs. For surgeons experienced in open and thoracoscopic lobectomy, appropriate patient selection coupled with the specific robotic techniques described may flatten the learning curve.

Keywords: Learning curve; Lobectomy; Lung cancer; Robotics.