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. 2024 Mar 14;13(6):1653.
doi: 10.3390/jcm13061653.

Robotic Lobectomy Learning Curve Has Better Clinical Outcomes than Videothoracoscopic Lobectomy

Pablo Luis Paglialunga  1 , Laureano Molins  1   2 , Rudith Guzmán  1 , Angela Guirao  1   2 , Irene Bello  1   2 , Anna Ureña  1 , Leandro Grando  1 , Nestor Quiroga  1 , Xavier Michavila  1 , Marc Boada  1
Affiliations

Robotic Lobectomy Learning Curve Has Better Clinical Outcomes than Videothoracoscopic Lobectomy

Pablo Luis Paglialunga et al. J Clin Med. .

Abstract

Introduction: The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2-5) vs. 5 (4-5.8), p = 0.005) and hospital days (4 (3-6) vs. 5 (4-6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.

Keywords: learning curve; lobectomy; lung cancer; minimally invasive thoracic surgery (MITS); robotic-assisted thoracic surgery (RATS); surgical techniques; video assisted thoracic surgery (VATS).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Left: Port placement for VATS. 4 cm utility incision (blue line) was made in the 4th intercostal space (ICS). Camera port was placed at the 7th ICS (A), and a 1.5 cm incision was made at the 8th ICS. Right: Port placement for RATS lung resection. All ports including assistance (A) were placed in the eighth ICS, except for the anterior port, which was placed in sixth intercostal space. Abbreviations: RATS: robotic-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
Figure 2
Figure 2
CUSUM curve, for the surgery time of the lobectomies. The RATS learning curve was completed at 23 procedures while VATS required 28 interventions. Abbreviations: RATS: robot-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
Figure 3
Figure 3
Adjusted CUSUM curve, for the surgery time of the lobectomies. The RATS learning curve (a) was completed at 23 procedures while VATS (b) required 31 interventions. Abbreviations: RATS: robot-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
Figure 4
Figure 4
Lymph node counts for stations. Abbreviations: RATS: robot-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
Figure 5
Figure 5
Comparison between days of chest tube (a) and length of stay (b) between groups. Abbreviations: RATS: robotic-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
Figure 5
Figure 5
Comparison between days of chest tube (a) and length of stay (b) between groups. Abbreviations: RATS: robotic-assisted thoracic surgery; VATS: video-assisted thoracic surgery.
See this image and copyright information in PMC

References

    1. McKenna R.J. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J. Thorac. Cardiovasc. Surg. 1994;107:879–882. doi: 10.1016/S0022-5223(94)70344-2. - DOI - PubMed
    1. Yan T.D., Cao C., D’Amico T.A., Demmy T.L., He J., Hansen H., Swanson S.J., Walker W.S., Casali G., Dunning J., et al. Video-assisted thoracoscopic surgery lobectomy at 20 years: A consensus statement. Eur. J. Cardio-Thoracic Surg. 2013;45:633–639. doi: 10.1093/ejcts/ezt463. - DOI - PubMed
    1. Dziedzic D., Orlowski T. The Role of VATS in lung cancer surgery: Current status and prospects for development. Minim. Invasive Surg. 2015;2015:1–6. doi: 10.1155/2015/938430. - DOI - PMC - PubMed
    1. Lim E., Batchelor T.J., Dunning J., Shackcloth M., Anikin V., Naidu B., Belcher E., Loubani M., Zamvar V., Harris R.A., et al. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. NEJM Evid. 2022;1:1–12. doi: 10.1056/EVIDoa2100016. - DOI - PubMed
    1. Melfi F.M., Menconi G.F., Mariani A.M., Angeletti C.A. Early experience with robotic technology for thoracoscopic surgery. Eur. J. Cardio-Thorac. Surg. 2002;21:864–868. doi: 10.1016/S1010-7940(02)00102-1. - DOI - PubMed

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