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. 2024 Sep 12:11:1417787.
doi: 10.3389/fsurg.2024.1417787. eCollection 2024.

Robotic thoracic surgery: lessons learned from the first 1,000 procedures

Marion Durand  1 , Lee S Nguyen  2 , Frankie Mbadinga  3 , Maksim Pryshchepau  1 , Hadrien Portefaix  4 , Nouha Chaabane  1 , Stanislas Ropert  5 , Naziha Khen-Dunlop  6
Affiliations

Robotic thoracic surgery: lessons learned from the first 1,000 procedures

Marion Durand et al. Front Surg. .

Abstract

Introduction: The aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.

Methods: In a single-center subset of the Epithor® database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann-Whitney-Wilcoxon test for continuous variables. Tests were considered significant for a p-value <0.05.

Results: Robotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9 ± 7 vs. 7 ± 5.6 days, p < 0.001), a shorter surgery time (99 ± 24 vs. 116 ± 38 min, p < 0.001) a lower conversion rate (n = 2 vs. n = 17, p = 0.004), and a lower complication rate (28% vs. 40%, p = 0.009, mainly Clavien-Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, p < 0.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%/20% to 30%/70% over the 9 years.

Discussion: A robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.

Keywords: RATS; lobectomy; non-small cell lung cancer; robot-assisted thoracic surgery; segmentectomy; sub-lobar resection.

PubMed Disclaimer

Conflict of interest statement

MD is official proctor for Intuitive Surgical. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Robotic procedure distribution n = 1,067. Upper bilobectomy n = 15, lower bilobectomy n = 4, and pneumonectomy N = 7.
Figure 2
Figure 2
Console time per procedure (orange line shows a linear tendency curve).
Figure 3
Figure 3
Chest drain length by chronological order of patient (each patient is a dot and the red line is a linear tendency curve).
Figure 4
Figure 4
Lobe vs. segment distribution over the years.
See this image and copyright information in PMC

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