Louie, B. E., A. S. Farivar, et al. (2012). “Early Experience With Robotic Lung Resection Results in Similar Operative Outcomes and Morbidity When Compared With Matched Video-Assisted Thoracoscopic Surgery Cases.” Annals of Thoracic Surgery.
BACKGROUND: Robotic lung resection is gaining popularity despite limited published evidence. Comparative studies are needed to provide information about the safety and effectiveness of robotic resection. Therefore, we compared our initial experience with robotic anatomic resection to our most recent video-assisted thoracoscopic surgery (VATS) cases. METHODS: A case-control analysis of consecutive anatomic lung resections by robot or VATS from 2009 through 2011 was performed. RESULTS: In the robotic group, 52 resections were attempted. Three conversions and 3 wedges were excluded, leaving 40 lobectomies, 5 segments, and 1 conversion to VATS. In the VATS group, 35 resections were attempted with 1 conversion. The distribution of resected lobes or segments and demographics was similar. Clinical outcomes between robotics and VATS were similar in tumor size (2.8 versus 2.3 cm), operative time (213 versus 208 minutes), blood loss (153 versus 134 mL), intensive care unit stay (0.9 versus 0.6 days), and length of stay (4.0 versus 4.5 days). There was no operative mortality. Major (n = 8; 17%) and minor morbidity (n = 12; 26%) with robotics was similar to VATS. The percentage of expected nodal stations sampled was similar. The duration of narcotic use after discharge (p = 0.039) and the time to return to usual activities (p = 0.001) was shorter in the robotic group. CONCLUSIONS: Early experience with robotic resection resulted in similar outcomes compared with mature VATS cases. A potential benefit of robotics may relate to postoperative pain reduction and earlier return to usual activities. Robotic lung resection should be studied further in selected centers and compared with VATS in a randomized fashion to better define its potential advantages and disadvantages.
Mussi, A., O. Fanucchi, et al. (2012). “Robotic extended thymectomy for early-stage thymomas.” European Journal of Cardio-Thoracic Surgery 41(4): e43-47.
OBJECTIVES: The aim of this study was to report a single referral centre experience in robotic extended thymectomy for clinical early-stage thymomas, evaluating its safety, feasibility and efficacy, with special regard to oncological outcomes. METHODS: Between April 2002 and February 2011, we retrospectively selected all those patients who underwent robotic thymectomy for clinical early-stage thymomas. Operative time, morbidity, mortality, duration of hospitalization and overall and disease-free survival were analysed. RESULTS: There were 14 patients (8 males, 6 females) with a mean age of 65.2 years (range 23-81). One patient suffered from myasthenia gravis. The WHO classifications were: A in two cases, AB in four cases, B1 in three cases, B2 in two cases and B3 in three cases. The Masaoka stages were: I in seven cases, IIA in four cases, IIB in two cases and III in one case. The mean operative time was 139 min. No intra-operative complication or death occurred. Conversion to open surgery was required in two cases. Minor complications occurred in two patients (14.2%) due to pleural effusion. The mean hospitalization was 4.0 days. Five patients underwent adjuvant radiotherapy. All patients were alive with no disease recurrence, with a median follow-up of 14.5 months (range 1-98). CONCLUSIONS: Robotic thymectomy is a safe and feasible technique, with a short operative time and low morbidity. Even on a small series with short follow-up, robotic extended thymectomy for thymoma appeared to be an effective treatment for early-stage thymomas.
Nakamura, H., Y. Taniguchi, et al. (2012). “First experience of robotic extended thymectomy in Japan for myasthenia gravis with thymoma.” Gen Thorac Cardiovasc Surg 60(3): 183-187.
We performed robot (da Vinci)-assisted thoracoscopic extended thymectomy (rThx) for myasthenia gravis with thymoma. The patient was a 66-year-old woman who complained of palpebral heaviness. Robotic operation was performed in the supine position by placing four ports in the right chest wall under 10 mmHg CO(2) insufflation using three arms and one assist port. Compared with conventional video-assisted thoracic surgery (VATS), the bilateral upper horns, fat around the diaphragm, and aortopulmonary window could be resected more easily. The tumor measured 41 mm maximum diameter and was diagnosed as type AB noninvasive thymoma. The operating time was 298 min, console operating time was 203 min, and the amount of bleeding was small. The postoperative course was uneventful with no complications. This is a report of the first Japanese case of rThx for myasthenia gravis. rThx is a promising technique, and further improvement in the procedure is expected.
Veronesi, G., B. G. Agoglia, et al. (2011). “Experience with robotic lobectomy for lung cancer.” Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6(6): 355-360.
Objective: In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation. Methods: Ninety-one patients with suspected or proven clinical stage I-III lung cancer underwent robotic lobectomy. Selection criteria included lesion <5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy. Results: Median duration of operation was 239 (range 85-411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P=0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P=0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease. Conclusions: Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery. Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery.