Abstract
Purpose
Minimally invasive lung lobectomy was introduced in the late 1990s. Since that time, various different approaches have been described. At our institution, two different minimally invasive approaches, a robotic and a conventional thoracoscopic one, were performed for pulmonary lobectomies. This study compares perioperative outcome of the two different techniques in a learning curve setting.
Methods
Between 2001 and 2008, 26 patients underwent lung lobectomy with a robotic-assisted thoracoscopic surgery (RATS) technique. In 2009, the minimally invasive approach was changed to a conventional video-assisted thoracoscopic surgery (VATS) technique. Perioperative results of the first 26 VATS patients were compared to the results of the robotic group.
Results
There were significantly more patients with clinical stage >IB in the VATS group than in the robotic-assisted group (23.1 vs. 0 %). Otherwise, demographic data were equal between the groups. Operative time was significantly longer in the robotic group (215 vs. 183 min, p = 0.0362). Median difference between preoperative hemoglobin levels and levels on postoperative day 1 was higher in the RATS group, suggesting a higher blood loss. No difference was found in conversion rate, acute phase protein levels (C-reactive protein), chest drain duration, postoperative morbidity and mortality, and length of hospital stay. Procedural costs were higher for the robotic approach (difference, 770.55 €, i.e., 44.4 %).
Conclusions
Shorter operative times, a lower drop of postoperative hemoglobin levels indicating less blood loss, and lower procedural costs suggest a benefit of the VATS approach over the robotic approach for minimally invasive lung lobectomy.
Similar content being viewed by others
References
Manser R, Wright G, Hart D, Byrnes G, Campbell D (2005) Surgery for early stage non-small cell lung cancer. Cochrane Database Syst Rev. doi:10.1002/14651858
McKenna RJ (1994) Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg 107:879–881
Rocco G, Internullo E, Cassivi SD, Van Raemdonck D, Ferguson MK (2008) The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin 18:235–247
Grogan EL, Jones DR (2008) VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes? Thorac Surg Clin 18:249–258
Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA (2008) 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 86:2016–2018
Yan TD, Black D, Bannon PG, McCaughan BC (2009) 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 27:2553–2562
Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole DH Jr, D’Amico TA (2007) Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83:1245–1249
Dieter RA, Kuzycz GB (1997) Complications and contraindications of thoracoscopy. Int Surg 82:232–239
Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 25:844–851
Melfi FM, Mussi A (2008) Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin 18:289–295
Gharagozloo F, Margolis M, Tempesta B (2008) Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg 85:1880–1885
Augustin F, Bodner J, Wykypiel H, Schwinghammer C, Schmid T (2011) Initial experience with robotic lung lobectomy: report of two different approaches. Surg Endosc 25:108–113
Kushner I (1982) The phenomenon of the acute phase response. Ann N Y Acad Sci 389:39
Kirby TJ, Rice TW (1993) Thoracoscopic lobectomy. Ann Thorac Surg 56:784–786
Kirby TJ, Mack MJ, Landreneau RJ, Rice TW (1995) Lobectomy—video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg 109:997–1001, discussion 1001-1002
McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81:421–425, discussion 425-426
Watanabe A, Mishina T, Ohori S, Koyanagi T, Nakashima S, Mawatari T, Kurimoto Y, Higami T (2008) Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur J Cardiothorac Surg 33:812–818
Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, Sato H, Abe T (2005) Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 138:510–517
Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, Kondo T (2002) A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 73:900–904
Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ (2011) Initial consecutive experience of completely portal robotic pulmonary resection with four arms. J Thorac Cardiovasc Surg 142:740–746
Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, Chin C, Swanson SJ (2008) Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 85:705–709
Augustin F, Bodner J, Wykypiel H, Schwinghammer C, Schmid T (2012) Perioperative results of robotic lung lobectomy: summary of literature. Surg Endosc 26:1190–1191
Park BJ, Flores RM (2008) Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin 18:297–300
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 93:1598–1605
Jang HJ, Lee HS, Park SY, Zo JI (2011) Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: a single-institution case series matching study. Innovations 6:305–310
Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J (2011) Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg 91:1961–1965
Flores RM, Alam N (2008) Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 85:710–715
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Augustin, F., Bodner, J., Maier, H. et al. Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting. Langenbecks Arch Surg 398, 895–901 (2013). https://doi.org/10.1007/s00423-013-1090-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-013-1090-5