PURPOSE: Robotic surgical systems have the potential to overcome the shortcomings associated with video assisted lobectomy, which include limitation of complex 3-D maneuvers and fine dissection. This study describes the use of the da Vinci surgical robot for minimally invasive lobectomy in patients with early stage lung cancer.
METHODS: Over a 50 month period 77 patients (33 men, 44 women, mean age 66.96 years) underwent a robotic lobectomy and complete mediastinal nodal dissection for early stage lung cancer (Stages I,II).
RESULTS: Lobectomies were RUL 22, RML 6, RLL 13, LUL 24, LLL 12. Operative times were 3 to 6 hrs (median 4 hours). There were 44 ACA, 19 SCCA, 6 adenosquamous, 1 large cell, 2 bronchoalveolar, 2 poorly differentiated, 1 carcinoid, 1 mucoepidermoid ca, 1 spindle cell ca. Pathologic upstaging was noted in 13 patients (8 IIb, 5 IIIa). There were no emergent conversions to a thoracotomy, one non-emergent conversion secondary to a dura leak. Median hospitalization was 4 days. Complications included A-fib (10), hydropneumothorax (1), atelectasis (4), prolonged air leak (3), pleural effusion (2), pulmonary embolism (2). Mortality was 2.6% (2/77). Both deaths were due to respiratory failure and pneumonia in patients who had severely depressed lung function pre-operatively (FEV1 < 800) and required a prolonged operation. Both deaths were early on in the robotic experience among the first 20 procedures. There have been no deaths in the last 50 patients. Follow up was complete in 68 patients (88%). At a mean follow up of 28 months, 1 patient had died (1/68) from their cancer and 4 had distant metastases. There was no local recurrence.
CONCLUSION: Robot-assisted VATS lobectomy for early stage lung cancer is safe and is associated with low morbidity, low local recurrence, and short hospitalization.
CLINICAL IMPLICATIONS: Robot-asssistance enhances the technique of VATS Lobectomy for early stage lung cancer.
DISCLOSURE: Farid Gharagozloo, None.