Cardiothoracic Surgery |

Feasibility of Hybrid Robotic-Assisted Pulmonary Lobectomy With En Bloc Chest Wall Resection and Reconstruction FREE TO VIEW

Eric Toloza, PhD; Kathryn Rodriguez; Frank Velez-Cubian; Wei Wei Zhang; Matthew Thau, BA; Carla Moodie; Joseph Garrett, MPH; Kamran Aghayev; Jacques Fontaine; Lary Robinson; Frank Vrionis
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Moffitt Cancer Center, Tampa, FL

Chest. 2014;146(4_MeetingAbstracts):89A. doi:10.1378/chest.1995241
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: We investigated the feasibility, safety, and oncologic efficacy of hybrid robotic-assisted video-thoracoscopic pulmonary lobectomy with en bloc chest wall resection.

METHODS: We retrospectively analyzed 5 consecutive patients who underwent hybrid robotic-assisted thoracoscopic lobectomy with en bloc chest wall resection for lung cancer over 15 months. The daVinci robotic system was used to perform pulmonary hilar dissection and complete mediastinal lymph node dissection, followed by limited thoracotomy for en bloc chest wall resection and reconstruction with titanium rib plates +/- absorbable mesh, while avoiding rib spreading.

RESULTS: Of 5 patients studied, 1 patient had preoperative chemotherapy; none had preoperative radiation. There were 3 right upper lobectomies and 2 left upper lobectomies. Median operative (skin-to-skin) time was 327+/-41 min, with median intraoperative estimated blood loss (EBL) of 900+/-326 mL. There was 1 conversion to open lobectomy due to pulmonary artery bleeding, but no intraoperative deaths. One patient required partial vertebrectomy of T2+T3. There were 2 squamous cell carcinomas and 3 adenocarcinomas, and complete resection was achieved in all 5 patients. Mean tumor size was 6.7+/-1.0 cm (range 3.5-9.5 cm), and mean of 3.0+/-0.5 ribs were resected, with mean of 1.4+/-0.4 ribs plated with titanium rib plates. Vicryl mesh was used in 2 cases which had more than 3 ribs resected. Mean # of mediastinal (N2) lymph node (LN) stations resected was 3.6+/-0.9 N2 stations, and mean # of mediastinal lymph nodes resected was 8.2+/-2.4 N2 LN (range 3-17 LN). Four patients had 7 postoperative complications, including 2 aspirations, 1 prolonged air leak, 1 brachial plexopathy, 1 recurrent laryngeal neuropathy, 1 atrial fibrillation, and 1 transfusion. Median chest tube duration was 5+/-5 days, and median hospital length of stay (LOS) of 7+/-1 days, with no in-hospital deaths.

CONCLUSIONS: Hybrid robotic-assisted pulmonary lobectomy with en bloc chest wall resection and reconstruction is feasible and safe in selected patients.

CLINICAL IMPLICATIONS: Patients with primary lung cancer involving the chest wall can undergo minimally invasive surgery for pulmonary hilar dissection and complete mediastinal lymphadenectomy, with limited thoracotomy for the necessary chest wall reconstruction and benefit from smaller incisions, less pain, shorter hospital stays, and quicker recovery.

DISCLOSURE: Eric Toloza: Consultant fee, speaker bureau, advisory committee, etc.: Honoraria for daVinci robotic surgical system proctor and observation site The following authors have nothing to disclose: Kathryn Rodriguez, Frank Velez-Cubian, Wei Wei Zhang, Matthew Thau, Carla Moodie, Joseph Garrett, Kamran Aghayev, Jacques Fontaine, Lary Robinson, Frank Vrionis

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