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. 2019 Nov;11(11):4807-4815.
doi: 10.21037/jtd.2019.10.48.

Current status and evolution of robotic-assisted thoracic surgery in Germany-results from a nationwide survey

Thorben Möller  1 , Jan-Hendrik Egberts  1 , Martin Eichhorn  2 , Hans-Stefan Hofmann  3 , Ingo Krüger  4 , Jens-C Rückert  5 , Tim Sandhaus  6 , Matthias Steinert  6
Affiliations

Current status and evolution of robotic-assisted thoracic surgery in Germany-results from a nationwide survey

Thorben Möller et al. J Thorac Dis. 2019 Nov.

Abstract

Background: Robot-assisted surgery has made a significant entry into surgical practice within Germany, including thoracic surgery. As no published data exists regarding robotic-assisted thoracic surgery (RATS), we conducted a survey to investigate its current status.

Methods: We performed a nationwide survey of all centers active in RATS, using a standardized questionnaire. The annual number of operations, mean duration of surgery, docking time, length of hospital stay(s), conversions, chest tube duration, the RATS program start date, robot system used, operating room capacity, and staplers and instruments used were recorded.

Results: Of the 22 centers contacted, 14 responded. In total, 786 RATS interventions were recorded. Most were anatomical lung resections, comprising 372 (bi-) lobectomies and 80 segmentectomies. During the study period, eight bronchoplastic procedures were performed robotically. There were 93 wedge lung resections, 148 thymectomies, 26 sympathectomies, and 59 other RATS procedures, and a single-center series of around 1,000 RATS thymectomies (excluded from statistical analysis). The average incision-suture time of the RATS lobectomy was 245 (range, 80-419) minutes, average residence time seven days. The conversion rate was 6.7% across all interventions, with significant inter-intervention differences. All surveyed centers plan to further expand RATS, with OR capacity being a frequent impediment. Five RATS interventions were performed in Germany in 2013, versus 320 in 2018.

Conclusions: Overall, RATS is becoming more established in everyday clinical practice in Germany. The number of operations, active centers, and trained RATS surgeons has increased steadily since 2013. A German-speaking operation course for entry into RATS already exists. Even extended resections can be carried out safely, and RATS has become standard procedure in some centers.

Keywords: Germany; Thoracic surgery; robotic-assisted thoracic surgery (RATS); robotics.

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Conflict of interest statement

Conflicts of Interest: JH Egberts, JC Rückert are working as a proctor for intuitive. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Geographic distribution of centers with an active robotic program in Germany. Responding centers are displayed in green, non-responding centers in redRATS, robotic-assisted thoracic surgery.
Figure 2
Figure 2
Development of RATS in Germany by year.
Figure 3
Figure 3
Distribution and development of robotic anatomic lung resections per year.
Figure 4
Figure 4
Distribution of RATS procedures 2013 to 2018 in Germany. RATS, robotic-assisted thoracic surgery.
Figure 5
Figure 5
Mean incision-to-suture time for different RATS procedures. RATS, robotic-assisted thoracic surgery.
Figure 6
Figure 6
Mean postoperative stay for different RATS procedures. RATS, robotic-assisted thoracic surgery.
Figure 7
Figure 7
Operative time, postoperative stay, and conversion rate for RATS-lobectomy, separated by high- and low-volume centers. RATS, robotic-assisted thoracic surgery.
See this image and copyright information in PMC

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