PURPOSE: Robotics enables anatomic lobectomy by video assisted techniques without the need for a utility thoracotomy. We present one institution's intermediate follow up experience with 175 consecutive robotic lobectomies for early stage lung cancer.
METHODS: Over a 62 month period, 175 patients (96 men, 79 women), mean age 66.2 years, underwent robotic video assisted anatomic lobectomy. The robot was used for vascular and bronchial dissection through three 2 cm ports followed by division of these structures using conventional video assisted techniques. A utility thoracotomy was not used. This technique was designed to replicate lobectomy by thoracotomy.
RESULTS: The median operative time was 3 hours. The distribution of lobectomies was RUL 49, RML 12, RLL 29, LUL 51, and LLL 34. Distribution of cancer includes: 111 adenocarcinoma, 34 squamous cell, 9 adenosquamous, 1 large cell, 10 bronchoalveolar, 5 poorly differentiated, 3 carcinoid, 1 mucoepidermoid, 1 spindle cell. There were two emergent conversions to a thoracotomy, and one non-emergent conversion to repair a dural leak. Median hospitalization was 4 days. Complications included A-fib (23), hydropneumothorax (1), atelectasis (7), prolonged air leak (11), pleural effusion (9), pulmonary embolism (5). There were 2 deaths in the first 20 patients; mortality in the last 155 patients was 0. Pathologic upstaging was noted in 30 patients (17%); 18 patients to IIB, 12 to IIIA. Mean follow up of 40 months: death from cancer 6 (3.4 %), distant metastases 7 (4%), new lung primary 5 (3%), and local recurrence 1 (0.6%).
CONCLUSION: Robotic lobectomy is associated with low morbidity and mortality. Low local recurrence rate and pathologic upstaging may be due to enhanced visualization and more accurate and extensive mediastinal and hilar nodal dissection afforded by the robot. The results improve significantly with greater experience.
CLINICAL IMPLICATIONS: Robotics enables minimally invasive anatomic lobectomy comparable in technique to lobectomy by thoracotomy.
DISCLOSURE: Farid Gharagozloo, No Financial Disclosure Information; No Product/Research Disclosure Information