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Robotic Versus Video-Assisted Thoracoscopic Lobectomy (VATS) for Lung Cancer

  • Thoracic Surgery (G. Rocco and M. Scarci, Section Editors)
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Abstract

Purpose of Review

Video-assisted thoracoscopic (VATS) lobectomy has been demonstrated to be a safe procedure, and it is known to provide less postoperative pain, similar lymph node dissection capabilities, decreased length of postoperative stay, less complications, reduced mortality, and similar oncologic outcomes compared with open lobectomy lung cancer operations.

Recent Findings

A recently developed approach for lobectomy is robotic surgery. Although both techniques are minimally invasive, there are differences between the approaches. The most important question is “could robotic-assisted surgery cover the limitations of video-assisted thoracoscopic lobectomy at a similar cost in the near future?”

Summary

This article discusses the concerns of both techniques and the future expectations.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • McKenna RJ, Houck W, Fuller JB. Video-assisted thoracic surgery lobectomy: experience with 1100 cases. Ann Thorac Surg. 2006;81:421–6. This is a cornerstone paper for the feasibility of VATS lobectomy. This series mostly includes the experience of a single surgeon.

  2. Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure. Ann Surg. 2006;244:420–5.

    PubMed  PubMed Central  Google Scholar 

  3. Cao C, Manganas C, Ang SC, et al. A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy. Ann Cardiothorac Surg. 2012;1:16–23.

    PubMed  PubMed Central  Google Scholar 

  4. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early stage non-small-cell lung cancer. J Clin Oncol. 2009;27:2553–62.

    Article  PubMed  Google Scholar 

  5. Rueth NM, Andrade RS. Is VATS lobectomy better: perioperative, biologically and oncologically? Ann Thorac Surg. 2010;89:2107–11.

    Article  Google Scholar 

  6. D’Amico TA, Niland J, Mamet R, et al. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg. 2011;92:226–31.

    Article  PubMed  Google Scholar 

  7. Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009;138:419–25.

    Article  PubMed  Google Scholar 

  8. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86:2008–16.

    Article  PubMed  Google Scholar 

  9. Flores RM, Park BJ, Dycoco J, Aronova A, Hirth Y, Rizk NP, et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009;138:11–8.

    Article  PubMed  Google Scholar 

  10. Flores RM, Alam N. Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg. 2008;85(suppl):710–5.

    Article  Google Scholar 

  11. Flores RM, Ihekweazu UN, Rizk N, et al. Patterns of recurrence and incidence of second primary tumors after lobectomy by means of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2011;141:59–64.

    Article  PubMed  Google Scholar 

  12. Denlinger C, Fernandez F, Meyers B, Pratt W, Zoole J, Patterson G, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg. 2010;89:1730–6.

    Article  PubMed  Google Scholar 

  13. Sagawa M, Sato M, Sakurada A, Matsumura Y, Chiaki C, Handa M, et al. A prospective trial systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg. 2002;73:900–4.

    Article  PubMed  Google Scholar 

  14. Ramosa R, Girarda P, Masueta C, Validireb P, Gossot D. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs. thoracotomy. Eur J Cardiothorac Surg. 2012;41(6):1342–8.

    Article  Google Scholar 

  15. Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, et al. Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg. 2010;89:353–9.

    Article  PubMed  Google Scholar 

  16. Bofa DJ, Dosinski AS, Paul S. Lymph node evaluation by open or video-assisted approaches in 11500 anatomic lung cancer resections. Ann Thorac Surg. 2012;94:347–53.

    Article  Google Scholar 

  17. • Swanson S, Herndon J, D’Amico T, Demmy T, McKenna R, Green M, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-A prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–7. This is an important article demonstrating feasibility of VATS lobectomy.

  18. Gopaldas RR, Bakaeen FG, Dao TK, et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann Thorac Surg. 2010;89:1563–70.

    Article  PubMed  Google Scholar 

  19. Dylewski MR, Lazzaro RS. Robotics—the answer to the Achilles’ heel of VATS pulmonary resection. Chin J Cancer Res. 2012;24(4):259–60.

    Article  PubMed  PubMed Central  Google Scholar 

  20. David G, Gunnarsson CL, Moore M, et al. Surgeons’ volume-outcome relationship for lobectomies and wedge resections for cancer using video-assisted thoracoscopic techniques. Minim Invasive Surg. 2012;2012:760292. doi:10.1155/2012:760292 Epub 2012 Nov 4.

    PubMed  PubMed Central  Google Scholar 

  21. Flores RJ, Ihekweazu U, Dycoco J, et al. Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg. 2011;142:1412–7.

    Article  PubMed  Google Scholar 

  22. • Li X, Wang J, Ferguson M. Competency versus mastery: the time course for developing proficiency in video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg. 2014;147:1150–4. This paper demonstrates the long competency period in VATS lobectomy operations. VATS lobectomy depends on the surgeons’ volume.

  23. Gutow AP. Surgeon volume and operative mortality. N Engl J Med. 2004;350(12):1256–8.

    Article  CAS  PubMed  Google Scholar 

  24. • Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94(2):145–61. Surgeon volume is important factor in surgery.

  25. Gruen RL, Pitt V, Green S, Parkhill A, Campbell D, Jolley D. The effect of provider case volume on cancer mortality: systematic review and meta-analysis. CA Cancer Journal for Clinicians. 2009;59(3):192–211.

    Article  Google Scholar 

  26. Cerfolio RJ, Brayn AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg. 2011;142:740–6.

    Article  PubMed  Google Scholar 

  27. •• Park BJ, Melfi F, Mussi A, et al. Robotic lobectomy for non-small cell lung cancer (NSCLC): long term oncologic results. J Thorac Cardiovasc Surg. 2012;143:383–9. Yet, one of the most important paper demonstrating similar survival with traditional surgery after robotic lobectomy operations.

  28. Pardolesi A, Park B, Petrella F, et al. Robotic anatomic segmentectomy of the lung: technical aspects and initial results. Ann Thorac Surg. 2012;94:929–34.

    Article  PubMed  Google Scholar 

  29. Toker A, Ayalp K, Uyumaz E, Kaba E, Demirhan Ö, Erus S. Robotic lung segmentectomy for malignant and benign lesions. J Thorac Dis. 2014;6(7):937–42.

    PubMed  PubMed Central  Google Scholar 

  30. Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23:36–42.

    Article  PubMed  Google Scholar 

  31. Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg. 2006;131(1):54–9.

    Article  PubMed  Google Scholar 

  32. Gharagozloo F, Margolis M, Tempesta B. Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg. 2008;85(6):1880–5 discussion 1885–6.

    Article  PubMed  Google Scholar 

  33. Veronesi G, Galetta D, Maisonneuve P, Melfi F, Schmid RA, Borri A, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg. 2010;140(1):19–25.

    Article  PubMed  Google Scholar 

  34. Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg. 2011;142(4):740–6.

    Article  PubMed  Google Scholar 

  35. Louie BE, Farivar AS, Aye RW, Vallières E. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg. 2012;93(5):1598–605.

    Article  PubMed  Google Scholar 

  36. Jang HJ, Lee HS, Park SY, Zo JI. Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer. Innovations. 2011;6(5):305–10.

    PubMed  Google Scholar 

  37. Demmy TL, James TA, Swanson SJ, McKenna RJ, D’Amico TA. Troubleshooting video-assisted thoracic surgery lobectomy. Ann Thorac Surg. 2005;79:1744–53.

    Article  PubMed  Google Scholar 

  38. Mitchell JD. Techniques of VATS lobectomy. J Thorac Dis. 2013;5(Suppl 3):177–81.

    Google Scholar 

  39. •• Wilson JL, Louie BE, Cerfolio RJ, et al. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg. 2014;97:1901–7. The importance of nodal upstaging and variations with surgical techniques are demonstrated in this article.

  40. Toker A, Özyurtkan O, Demirhan O, Ayalp K, Kaba E, Uyumaz E. Lymph node dissection in surgery for lung cancer: comparison of open vs. video-assisted vs. robotic-assisted approaches. Ann Thorac Cardiovasc Surg. 2008. doi:10.5761/atcs.oa.16-00087.

    Google Scholar 

  41. Lee PC, Nasar A, Port JL, et al. Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2013;96:951–60.

    Article  PubMed  Google Scholar 

  42. Kent M, Wang T, Whyte R, Curran T, Flores R, Gangadharan S. Open, Video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg. 2014;97:236–44.

    Article  PubMed  Google Scholar 

  43. •• Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2016;4975(16):30134–5. This database evaluates quality metrics for VATS and robotic surgery lobectomy techniques in primary non-small-cell lung cancers (NSCLCs) with clinical stage I or stage II disease at high-volume centers from 2009 to 2013.

  44. Swanson S, Miller DL, McKenna JR Jr, et al. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg. 2014;147:929–37.

    Article  PubMed  Google Scholar 

  45. Toker A, Özyurtkan MO, Kaba E, Ayalp K, Demirhan Ö, Uyumaz E. Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc. 2016;30(2):676–83.

    Article  PubMed  Google Scholar 

  46. Hernandez J, Bann S, Munz K, Moorthy K, Datta V, Martin S, Dosis A, Bello F, Darzi A, Rockall T. Qualitative and quantitative analysis of the learning curve of a simulated task on the da Vinci system. Surg Endosc. 2004;18:372–8.

    Article  CAS  PubMed  Google Scholar 

  47. Meyer M, Gharagozloo F, Tempesta B, Margolis M, Strother E, Christenson D. The learning curve of robotic lobectomy. Int J Med Robotics Comput Assist Surg. 2012;8:448–52.

    Article  Google Scholar 

  48. Melfi FMA, Mussi A. Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin. 2008;18:289–95.

    Article  PubMed  Google Scholar 

  49. Gharagozloo F, Margolis M, Tempesta B, Strother E, Najam F. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg. 2009;88:380–4.

    Article  PubMed  Google Scholar 

  50. Veronesi G, Agoglia BG, Melfi F, Maisonneuve P, Bertoletti R, Bianchi PP, Rocco B, Borri A, Gasparri R, Spaggiari L. Experience with robotic lobectomy for lung cancer. Innovations. 2011;6:355–60.

    PubMed  Google Scholar 

  51. Lee BE, Korst RJ, Kletsman E, Rutledge JR. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: are there outcomes advantages? J Thorac Cardiovasc Surg. 2014;147:724–9.

    Article  PubMed  Google Scholar 

  52. Sages report. Herron, DM, Marohn M, and The SAGES-MIRA Robotic Surgery Consensus Group. A Consensus Document on Robotic Surgery Prepared by the SAGES-MIRA Robotic Surgery Consensus Group. SAGES Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org.

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Correspondence to Alper Toker.

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This article is part of the Topical collection on Thoracic Surgery.

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Toker, A. Robotic Versus Video-Assisted Thoracoscopic Lobectomy (VATS) for Lung Cancer. Curr Surg Rep 4, 33 (2016). https://doi.org/10.1007/s40137-016-0155-0

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