Initial Multicenter Community Robotic Lobectomy Experience: Comparisons to a National Database

Abstract

In pulmonary lobectomy, video-assisted thoracoscopic surgery (VATS) offers advantages compared with open thoracotomy. However, various issues have limited its adoption, especially in community settings. Single surgeon studies suggest that completely portal robotic lobectomy (CPRL) may address such limitations. This multicenter study evaluates early CPRL experience in 6 community cardiothoracic surgeons' practices. Perioperative data from each surgeon's initial 20, consecutive and unselected cases of CPRL were retrospectively gathered (total n= 120) and compared with the 2009 and 2010 Society of Thoracic Surgeons database for VATS (n= 4,612) and open (n= 5,913) lobectomy. The χ(2) and t test procedures were used and significance was defined at the 95% confidence level (p<0.05). One hundred sixteen lobectomies (96.7%) were completed robotically with a conversion rate of3.3%. Preoperative patient characteristics were comparable across the CPRL, VATS, and open groups. The CPRL was equivalent to VATS on all intraoperative and postoperative outcomes, and resulted in significantly lower postoperative blood transfusion rates (0.9% vs 7.8%; p= 0.002), air leaks greater than 5 days (5.2% vs 10.8%; p= 0.05), chest tube duration (3.2 days vs 4.8 days; p < 0.001), and length of stay (4.7 days vs 7.3 days; p<0.001) when compared with open. For these outcomes, results trended favorably for CPRL over VATS. This early CPRL experience reveals a minimally invasive lobectomy technique that is safe and reproducible in varied practice settings. Outcomes were equivalent between CPRL and VATS, trending in favor of robotics. The CPRL was superior in several measures compared with open. The absence of patient selection and low conversion rates suggest a broad applicability of this technique.