The use of the robotic platform is increasingly being utilized for lung resections. Our aim was to compare outcomes of thoracoscopic (VATS) versus robotic-assisted thoracoscopic (RATS) lobectomy early in a program’s adoption of robotic surgery, including perioperative outcomes, cost, and long-term quality of life. A prospective database was retrospectively reviewed for all patients undergoing minimally invasive lobectomy by either VATS or RATS techniques from 2010 to 2012. Patients’ operative, post-operative complications, cost (operating room and hospital) and quality of life were compared between the two resection techniques. Long-term follow-up including assessment using the European Organization for Research and Treatment of Cancer quality of life questionnaire was documented. During the first 25 RATS lobectomies, there were 73 VATS lobectomies performed, for a total of 98 cases. There was no significant difference in cancer stage, operative time, estimated blood loss, lymph node count, or hospital length of stay. The RATS resections had significantly higher operative and total hospital cost (p < 0.0001 and p < 0.05). At a median of 65-month follow-up, 29 patients (9 robotic; 20 VATS) completed the EORTC questionnaire. The global health status and symptom scale median scores were similar to the general population and did not significantly differ between groups. While transitioning from thoracoscopic to robotic lobectomy incurs increased operative and total hospital cost, equivalent operative outcomes, length of hospitalization, and long-term quality of life can be maintained during this transition. With increasing patient and surgeon interest in robotic resection, it appears both safe and feasible to adopt this approach while maintaining outcomes.
Minimally invasive surgery Robotic surgery Lung cancer Patient quality of life Health care costs
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Conflict of interest
Drs. Reddy and Lin have received compensation serving as robotic educators and as speakers for Intuitive Surgical, Inc. Drs. Worrell, Dedhia, Gilbert, James, and Chang have no financial disclosures.
Paul S, Jalbert J, Isaacs AJ et al (2014) Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy. Chest 146(6):1505–1512CrossRefGoogle Scholar
Louie BE, Wilson JL, Kim S et al (2016) 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 102:917–924CrossRefGoogle Scholar
Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363(8):701–704CrossRefGoogle Scholar
Louie BE, Farivar AS, Aye RW, Vallières E (2012) 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 93:1598–1605CrossRefGoogle Scholar
Cerfolio RJ, Bryant AS (2012) Robotic-assisted pulmonary resection—right upper lobectomy. Ann Cardiothorac Surg 1(1):77–85Google Scholar
Cerfolio R, Louie B, Farivar AS et al (2017) Consensus statement on definitions and nomenclature for robotic thoracic surgery. J Thorac Cardiovasc Surg 154(3):1065–1069CrossRefGoogle Scholar
McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81(2):421–425 (discussion 425-6).CrossRefGoogle Scholar
Aaronson N, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–375CrossRefGoogle Scholar
Swanson SJ, Miller DJ, McKenna RJ et al (2014) Comparing robot-assisted thoracic surgical lobecotmy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database. J Thorac Cardiovasc Surg 147(3):929–937CrossRefGoogle Scholar
Higgins RM, Frelich MJ, Boslet ME, Gould JC (2017) Cost analysis of robotic versus laparoscopic general surgery proceudres. Surg Endo 31(1):185–192CrossRefGoogle Scholar
Bao F, Zhang C, Yang Y et al (2016) Comparison of robotic and video-assisted thoracic surgery for lung cancer: a propensity-matched analysis. J Thorac Dis 8(7):1798–1803CrossRefGoogle Scholar
Byrn JC, Hrabe JE, Charlotn ME (2014) An initial experience with 85 consecutive robotic assisted rectal dissections: improved operating times and lower costs with experience. Surg Endosc 28(11):3101–3107CrossRefGoogle Scholar
Meyer M, Gharagozloo F, Tempesta B et al (2012) The learning curve of robotic lobectomy. Int J Med Robot 8(4):448–452CrossRefGoogle Scholar
White YN, Dedhia P, Bergeron EJ et al (2016) Resident training in a new robotic thoracic surgery program. J Surg Res 201(1):219–225CrossRefGoogle Scholar
Honaker MD, Paton BL, Stefanidis D, Schiffern LM (2015) Can robotic surgery be done efficiently while training residents? J Surg Educ 72:377CrossRefGoogle Scholar
Cerfolio RJ, Bryant AS, Minnich DJ (2011) Starting a robotic program in general thoracic surgery: why, how, and lessons learned. Ann Thorac Surg 91:1729–1737CrossRefGoogle Scholar