Initial experience with robotic lung lobectomy: report of two different approaches.

BACKGROUND: Surgical resection is the gold standard for treatment of early-stage lung tumors. Different minimally invasive approaches are currently under investigation: In addition to conventional video-assisted thoracoscopic surgery (VATS), robotic technology with the da Vinci System has emerged over the past 10 years.

METHODS: In this series, 26 patients (12 women and 14 men; median age, 65 years) underwent a robotic lobectomy for early-stage lung tumors (clinical stage IA or IB) or centrally located metastases.

RESULTS: The resected lobes included four left upper lobes, six left lower lobes, eight right upper lobes, and eight right lower lobes. Five intraoperative conversions to open thoracotomy were performed due to one major bleeding, two minor bleedings, one variant course of the pulmonary artery, and one extended resection. The postoperative complications included two prolonged air leaks, one colonic perforation, and one atrial fibrillation. The median hospital stay was 11 days (range, 7-53 days). One 30-day mortality (3.8%) occurred due to respiratory failure. The overall median operative time was 228 min (range, 162-375 min). For the first five patients, the posterior approach was used. Thereafter, the authors switched to an anterior approach, thus enabling an easier hilar dissection. Technical modification within this series also included the introduction of a new vessel sealing device.

CONCLUSION: Robotic lobectomy was proved to be feasible and safe in our initial series in a learning curve setting. Changes in patient positioning and approach as well as technical modifications resulted in shorter operative times. A longer follow-up period and randomized controlled trials are necessary to evaluate a potential benefit over open and conventional VATS approaches.