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. 2025 Jun 24.
doi: 10.1007/s11748-025-02172-9. Online ahead of print.

Robotic-assisted versus open resection of pulmonary sequestration: a retrospective cohort study. RATS surgery for pulmonary sequestration

Henrike Deissner  1 , Alessio Campisi  1   2 , Raffaella Griffo  1 , Benedikt Niedermaier  1 , Thomas Muley  3   4 , Michael Allgäuer  3   5 , Hauke Winter  1   3 , Martin E Eichhorn  6   7
Affiliations

Robotic-assisted versus open resection of pulmonary sequestration: a retrospective cohort study. RATS surgery for pulmonary sequestration

Henrike Deissner et al. Gen Thorac Cardiovasc Surg. .

Abstract

Background: Pulmonary sequestration (PS) is a rare congenital lung malformation often requiring surgical resection due to recurrent infections or hemoptysis. Traditionally treated via open thoracotomy, recent advancements have made minimal-invasive approaches like robotic-assisted thoracoscopic surgery (RATS) increasingly viable. This study compares outcomes between RATS and open resection for PS in a high-volume center.

Methods: In this retrospective cohort study, 23 adult patients who underwent surgical resection of PS between 2010 and 2023 were analyzed. Fifteen patients were treated via open thoracotomy (THKT), while eight underwent RATS using the DaVinci-X system. We compared preoperative findings, intraoperative variables, and postoperative outcomes.

Results: The patients in the RATS group were younger (median age: 36 vs 47 years) and had a shorter median hospital stay (5 vs 10 days, p < 0.001) compared to the THKT group. The RATS group also experienced earlier chest drainage removal (3 vs. 4 days, p = 0.016). However, the median duration of surgery was longer for RATS (118 vs. 75 min, p = 0.018). A trend towards less postoperative complications was observed in the RATS group (33% vs. 0%).

Conclusions: RATS provides a safe and effective alternative to open surgery for PS resection, with benefits including reduced hospital stay and earlier chest tube removal. Despite longer operative times, the minimally invasive approach may offer enhanced recovery and fewer complications. Continued accumulation of experience with RATS is likely to improve operative efficiency, making it a valuable option in the surgical management of pulmonary malformations.

Keywords: Minimally invasive; Pulmonary sequestration; Robotic; Thoracotomy.

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Conflict of interest statement

Declarations. Conflict of interest: Martin Eichhorn and Hauke Winter received consulting fees from Intuitive Surgical and serve as proctors for Intuitive Surgical. Ethical approval and informed consent: The Heidelberg University Hospital’s institutional ethics committee approved the collection and analysis of data from the patient's medical record (No. S-089/2018, 01.03.2018) and the requirement for individual informed patient consent for this retrospective study was waived. All figures and tables are original and have not been published before.

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