Related Experiment Video
Updated: Oct 9, 2025
Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
Published on: April 19, 2024
Conversion to Thoracotomy During Thoracoscopic vs Robotic Lobectomy: Predictors and Outcomes
Elliot L Servais1, Daniel L Miller2, Dylan Thibault3
1Division of Thoracic and Cardiovascular Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Conversion to thoracotomy during minimally invasive lobectomy for lung cancer is more frequent with video-assisted thoracoscopic surgery (VATS) than robotic-assisted thoracoscopic surgery (RATS). While RATS conversions are more emergent, overall mortality and major complications are similar between VATS and RATS.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Conversion to thoracotomy during minimally invasive lobectomy for lung cancer is occasionally necessary.
- Differences between video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) lobectomy conversion have not been described.
Purpose of the Study:
- To describe differences between VATS and RATS lobectomy conversion rates, reasons, and outcomes.
- To identify predictors of conversion for both VATS and RATS lobectomy.
Main Methods:
- Analysis of The Society of Thoracic Surgeons General Thoracic Surgery Database (2015-2018).
- Inclusion of 27,695 minimally invasive lobectomies, excluding prior thoracic operations and metastatic disease.
- Univariable and multivariable logistic regression analyses were performed.
Main Results:
- Conversion occurred in 11.0% of VATS vs. 6.0% of RATS lobectomies (P < .001).
- RATS conversions were more emergent and for vascular injury, but overall major complications and mortality were similar.
- Lower volume centers had increased conversion rates for both VATS and RATS.
Conclusions:
- Conversion from VATS or RATS to open lobectomy is associated with increased morbidity and mortality.
- While VATS conversion is more frequent, RATS conversion is more emergent, with similar overall complication and mortality rates.
- Predictors and reasons for conversion differ between VATS and RATS, aiding patient selection.
