Robot-assisted thoracoscopic lobectomy for early-stage lung cancer

Video-assisted thoracic surgery lobectomy is an accepted oncologic procedure for patients with early-stage lung cancer. We studied the use of the da Vinci surgical robot for mediastinal, hilar, and vascular dissection during video-assisted thoracic surgery lobectomy in patients with early-stage lung cancer.

During a 41-month-period, 61 patients (27 men, 34 women; mean age, 68.2 years) underwent a robot-assisted video-assisted thoracic surgery lobectomy and complete mediastinal nodal dissection for early-stage lung cancer (stages I, II).

Distribution of lobectomies was right upper lobe 14, right middle lobe 6, right lower lobe 9, left upper lobe 21, and left lower lobe 11. Operative times ranged from 3 to 6 hours (median, 4). There were 34 adenocarcinoma, 14 squamous cell carcinoma, 6 adenosquamous, 1 large cell, 2 bronchoalveolar, 2 poorly differentiated cancers, and 2 carcinoid tumors. Pathologic upstaging was noted in 10 patients (8 to IIb, 2 to IIIa). There were no emergent conversions to a thoracotomy. Complications included atrial fibrillation (4), atelectasis (4), prolonged air leak (2), pleural effusion (2), hydropneumothorax (1), and incisional bleeding (1). Mortality was 4.9%. Median hospitalization was 4 days. Follow-up was complete in 54 patients (88%). At a mean follow-up of 28 months, all patients were alive, and 4 had distant metastases. There was no local recurrence.

Robot-assisted vascular and nodal dissection during video-assisted thoracic surgery lobectomy for early-stage lung cancer is feasible. Greater experience and long-term follow-up is required to better evaluate patient selection, oncologic efficacy, and comparability with a conventional open approach.