Institutional members access full text with Ovid®

Share this article on:

Comparing Robotic Lung Resection With Thoracotomy and Video-Assisted Thoracoscopic Surgery Cases Entered Into The Society of Thoracic Surgeons Database

Farivar, Alexander S. MD*; Cerfolio, Robert J. MD; Vallières, Eric MD*; Knight, Ariel W. BA*; Bryant, Ayesha MD; Lingala, Vijaya PhD; Aye, Ralph W. MD*; Louie, Brian E. MD*

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: January/February 2014 - Volume 9 - Issue 1 - p 10–15
doi: 10.1097/IMI.0000000000000043
Original Articles

Objective: The use of robotic lung surgery has increased dramatically despite being a new, costly technology with undefined benefits over standard of care. There is a paucity of published comparative articles justifying its use or cost. Furthermore, outcomes regarding robotic lung resection are either from single institutions with in-house historical comparisons or based on limited numbers. We compared consecutive robotic anatomic lung resections performed at two institutions with matched data from The Society of Thoracic Surgeons (STS) National Database for all open and video-assisted thoracoscopic surgery (VATS) resections. We sought to define any benefits to a robotic approach versus national outcomes after thoracotomy and VATS.

Methods: Data from all consecutive robotic anatomic lung resections were collected from two institutions (n = 181) from January 2010 until January 2012 and matched against the same variables for anatomic resections via thoracotomy (n = 5913) and VATS (n = 4612) from the STS National Database. Patients with clinical N2, N3, and M1 disease were excluded.

Results: There was a significant decrease in 30-day mortality and postoperative blood transfusion after robotic lung resection relative to VATS and thoracotomy. The patients stayed in the hospital 2 days less after robotic surgery than VATS and 4 days less than after thoracotomy. Robotic surgery led to fewer air leaks, intraoperative blood transfusions, need for perioperative bronchoscopy or reintubation, pneumonias, and atrial arrhythmias compared with thoracotomy.

Conclusions: This is the first comparative analysis using national STS data. It suggests potential benefits of robotic surgery relative to VATS and thoracotomy, particularly in reducing length of stay, 30-day mortality, and postoperative blood transfusion.

From the *Division of Thoracic and Foregut Surgery, Swedish Medical Center, Seattle, WA USA; †Division of Thoracic Surgery, University of Alabama-Birmingham, Birmingham, AL USA; and ‡Institute of Clinical Outcomes Research and Education, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA USA.

Accepted for publication December 6, 2013.

Supported by a restricted research grant from Intuitive Surgical, Sunnyvale, CA USA, to obtain data from The Society of Thoracic Surgeons National Database.

Disclosures: Robert J. Cerfolio, MD, is a consultant to Intuitive Surgical, Inc, Sunnyvale, CA USA. Eric Vallières, MD, serves on the Board of GSK-Bio, Philadelphia, PA USA, and Myriad, Salt Lake City, UT USA, and receives compensation as a member of the speaker’s bureau of Genentech, San Francisco, CA USA, and Synthes, Inc, West Chester, PA USA. Alexander S. Farivar, MD; Ariel Knight, BA; Ayesha Bryant, MD; Vijaya Lingala, PhD; Ralph W. Aye, MD; and Brian E. Louie, MD, declare no conflicts of interest.

Address correspondence and reprint requests to Alexander S. Farivar, MD, Division of Thoracic and Foregut Surgery, Swedish Medical Center, Madison Tower, 1101 Madison St, Suite 850, Seattle, WA 98104 USA. E-mail: alex.farivar@swedish.org.

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery