Self-assisting robot-assisted pulmonary lobectomy has favorable outcome compared to VATS lobectomy

Abstract

Background: Open and video-assisted thoracoscopic surgery (VATS) pulmonary lobectomy requires a skilled assistant to complete the operation. A potential benefit of a robot is to allow a surgeon to complete the operation autonomously. We sought to determine the safety of performing robotic-assisted pulmonary lobectomy with self-assistance.

Methods: We performed a retrospective analysis of self-assisting robot-assisted lobectomy. We evaluated the intraoperative and postoperative outcomes. We compared the outcome to the propensity matched group of patients who had VATS lobectomy. We also compared them to published outcomes of robot-assisted lobectomy.

Results: 95 patients underwent self-assisted lobectomies. The median age was 70 years old, predominately female (57%) and white (85%) with 90% of patients undergoing surgery for cancer. The median of estimated blood loss was 25 mL during the operation with no conversions to open thoracotomies. After the operation, 17% of patients had major postoperative complications with a median length of stay of 2 days. At thirty-day follow-up, the readmission rate was 6.5%, with a mortality of 0%. Compared to the propensity matched VATS lobectomy group, there was significantly less conversion to open surgery (n=0, 0% vs. n=10, 12.2%, P=0.002), less intraoperative blood transfusions (n=0, 0% vs. n=6, 7.3%, P=0.03), less any complications (n=20, 24.4% vs. n=41, 50%, P=0.003), and less median length of stay (2 days, IQR 2, 5 days vs. 4 day, IQR 3, 6 days, P<0.001) in the self-assisting robot lobectomy group. Compared to published outcomes of robot-assisted lobectomy, our series had significantly fewer conversions to open (P=0.03), shorter length of stay (P<0.001), more discharges to home (93.7%) without a difference in procedure time (P=0.38), overall complication rates (P=0.16) and mortality (P=0.62).

Conclusions: Self-assistance using the robot technology during pulmonary lobectomy had few technical complications and acceptable morbidity, length of stay, and mortality. This group had favorable outcome compared to VATS lobectomy. The ability to self-assist during pulmonary lobectomy is an additional benefit of the robot technology compared to open and VATS lobectomy.

Keywords: Robot lobectomy; autonomy; robot-assisted lobectomy; robotic lobectomy; self-assisting; video-assisted thoracoscopic surgery lobectomy (VATS lobectomy).

Video 1

Mobilization and division of the truncus anterior pulmonary artery during robot-assisted right upper lobectomy. Surgeon self-assists by retracting the lung posteriorly and controlling the camera. The pre-vascular plane is identified, and the tissue above the pulmonary artery is divided with a bipolar energy device. Prior to placing the vascular stapler, the truncus anterior branch of the pulmonary artery is mobilized fully, so when the stapler places around it, there is no tension on the artery. There is minimal bleeding during the dissection.

Figure 1

Four-port only port placement for pulmonary lobectomy. Ports for Arm #1, Arm #3, and Arm #4 are placed in the 7^th intercostal space, and the port for Arm #2 is placed in the 9^th intercostal space. This image is published with the patient consent.