Four-arm robotic lobectomy for the treatment of early-stage lung cancer

Veronesi, Giulia; Galetta, Domenico; Maisonneuve, Patrick; Melfi, Franca; Schmid, Ralph Alexander; Borri, Alessandro; Vannucci, Fernando; Spaggiari, Lorenzo

doi:10.1016/j.jtcvs.2009.10.025

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 1 , Pages 19-25, July 2010

Four-arm robotic lobectomy for the treatment of early-stage lung cancer

Preliminary data read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 9–13, 2009.

Giulia Veronesi, MD
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
- Address for reprints: Giulia Veronesi, MD, Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Domenico Galetta, MD
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
Patrick Maisonneuve, DipEng
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
Franca Melfi, MD
- Division of Thoracic Surgery, Ospedale Cisanello, Pisa, Italy
Ralph Alexander Schmid, MD
- Division of Thoracic Surgery, University Hospital Berne, Switzerland
Alessandro Borri, MD
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
Fernando Vannucci, MD
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
Lorenzo Spaggiari, MD, PhD
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
- School of Medicine, University of Milan, Italy

Received 29 April 2009; received in revised form 17 September 2009; accepted 23 October 2009. published online 28 December 2009.

Objectives

We investigated the feasibility and safety of four-arm robotic lung lobectomy in patients with lung cancer and described the robotic lobectomy technique with mediastinal lymph node dissection.

Methods

Over 21 months, 54 patients underwent robotic lobectomy for early-stage lung cancer at our institute. We used a da Vinci Robotic System (Intuitive Surgical, Inc, Mountain View, Calif) with three ports plus one utility incision to isolate hilum elements and perform vascular and bronchial resection using standard endoscopic staplers. Standard mediastinal lymph node dissection was performed subsequently. Surgical outcomes were compared with those in 54 patients who underwent open surgery over the same period and were matched to the robotic group using propensity scores for a series of preoperative variables.

Results

Conversion to open surgery was necessary in 7 (13%) cases. Postoperative complications (11/54, 20%, in each group) and median number of lymph nodes removed (17.5 robotic vs 17 open) were similar in the 2 groups. Median robotic operating time decreased by 43 minutes (P = .02) from first tertile (18 patients) to the second-plus-third tertile (36 patients). Median postoperative hospitalization was significantly shorter after robotic (excluding first tertile) than after open operations (4.5 days vs 6 days; P = .002).

Conclusions

Robotic lobectomy with lymph node dissection is practicable, safe, and associated with shorter postoperative hospitalization than open surgery. From the number of lymph nodes removed it also appears oncologically acceptable for early lung cancer. Benefits in terms of postoperative pain, respiratory function, and quality of life still require evaluation. We expect that technologic developments will further simplify the robotic procedure.

CTSNet classification: 10, 13, 28

Abbreviations and Acronyms: CT, computed tomography, FEV₁, forced expiratory volume in 1 second, VATS, video-assisted thoracic surgery