M. Huang1, B. Zwierzchowski1, W. Wong1, T. Demmy1, E. Dexter1, M. Hennon1, A. Picone1, W. Tan1, S. Yendamuri1, C. Nwogu1 1Roswell Park Cancer Institute,Buffalo, NY, USA
Introduction: A steadily increasing proportion of thoracic procedures are being performed via minimally invasive techniques. The literature has demonstrated that video-assisted thoracoscopic surgery (VATS) techniques have improved patient recovery time with fewer postoperative complications, and sustained long-term survivorship data equivalent to open thoracotomy for early stage lung cancer. However, the additional benefit of robotic video-assisted thoracic surgery (RVATS) remains controversial. As a prelude to a prospective trial comparing RVATS with conventional VATS for lobectomy, we conducted a retrospective review of all RVATS cases at an academic, tertiary referral center with a focus on lobectomy cases.
Methods: A review was conducted of 101 consecutive patients undergoing robotic-assisted thoracoscopic surgery between August 2005 and May 2015. Outcomes data collected include operative time, blood loss, duration of hospital and postoperative ICU stay, chest tube duration, conversion rates, and perioperative morbidity and mortality. In addition, a subset cost analysis compared direct costs and medical supply expenses for 10 lobectomy cases, each performed by RVATS, VATS, and thoracotomy.
Results: In this initial case series of 41 cases of RVATS lobectomy, patients had a median hospital length of stay of 4 days, ICU length of stay of 0 days, chest tube duration of 2 days, and an average blood loss of 151 mL. One patient (2.4%) that was electively converted to thoracotomy for a large upper and middle lobe tumor, died from pneumonia and respiratory failure. There were 6 (14.6%) cases converted to open thoracotomy. Direct costs for lobectomies performed by VATS, RVATS and thoracotomy were $23,306, $25,510 and $35,195, respectively.
Conclusion: Progressive incorporation of the surgical robot in an already advanced thoracoscopic program is feasible. The immediate postoperative outcomes after RVATS lobectomy are similar to what has been reported from our institution and others for VATS lobectomy. RVATS was modestly more expensive than VATS, but both were significantly cheaper than thoracotomy. A prospective comparison of RVATS and VATS would provide greater understanding of the precise benefits or lack thereof of the Da Vinci surgical robotic system for minimally invasive lung resections.