PURPOSE:Robotic surgical systems have the potential to enhance thoracoscopic Lobectomy by facilitating complex 3-D maneuvers and fine dissection. This video illustrates the use of the da Vinci surgical robot for thoracoscopic right upper 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). Both deaths were early on in the robotic experience. 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:Robotic lobectomy for early stage lung cancer is safe and is associated with low morbidity, low local recurrence, and short hospitalization.
CLINICAL IMPLICATIONS:Limited pulmonary reserve remains a challenge and may be a contraindication to robotic surgery.
DISCLOSURE:Farid Gharagozloo, None.