Related Experiment Video
Updated: Jun 18, 2025
Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
Adoption of Minimally Invasive Lung Resection: A National Cancer Database Study
Aria Bassiri1, Christina Boutros1, Boxiang Jiang1
1Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Introduction:
Minimally invasive lung resection has been associated with improved outcomes; however, institutional characteristics associated with utilization are unclear. We hypothesized that the presence of surgical robots at institutions would be associated with increased utilization of minimally invasive techniques .
Methods:
Patients with cT1/2N0M0 non-small cell lung cancer who underwent lung lobectomy between 2010 and 2020 in the National Cancer Database were identified. Patients were categorized by operative approach as minimally invasive surgery (MIS) versus open. Institutions were categorized as "high utilizers" of MIS technique if their proportion of MIS lobectomies was >50%. Multivariate logistic regressions were used to determine factors associated with proportion of procedures performed minimally invasively. Further multivariate models were used to evaluate the association of proportion of MIS procedures with 90-d mortality, hospital length of stay, and hospital readmission.
Results:
In multivariate analysis, passage of time by year (odds ratio [OR] 1.26; confidence interval [CI] 1.22-1.30) and presence of a robot at the facility (OR 3.48; CI 2.84-4.24) were associated with high MIS-utilizing facilities. High utilizers of MIS were associated with lower 90-d mortality (OR 0.89; CI 0.83-0.97) and hospital length of stay (coeff -0.88; CI -1.03 to -0.72). Hospital readmission was similar between high and low MIS-utilizing facilities (compared to low MIS-utilizing facilities: OR 1.06; CI 0.95-1.09).
Conclusions:
Passage of time and the presence of surgical robots were independently associated with increased utilization of MIS lobectomy. In addition to being associated with improved patient-level outcomes, robotic surgery is correlated with a higher proportion of procedures being performed minimally invasively.
Insights
Surgical robots and the passage of time are linked to increased minimally invasive surgery (MIS) for lung cancer. Higher MIS utilization at facilities correlates with better patient outcomes, including reduced mortality and shorter hospital stays.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Health Services Research
Background:
- Minimally invasive surgery (MIS) offers improved outcomes for lung resection, but institutional factors influencing its adoption remain unclear.
- This study investigates the association between institutional characteristics, specifically the presence of surgical robots, and the utilization of MIS lung resection.
Purpose of the Study:
- To identify institutional factors associated with the utilization of minimally invasive techniques in lung lobectomy.
- To evaluate the impact of institutional MIS utilization on patient outcomes such as mortality, length of stay, and readmission.
Main Methods:
- Analysis of cT1/2N0M0 non-small cell lung cancer lobectomy cases from 2010-2020 in the National Cancer Database.
- Categorization of institutions as high MIS utilizers (>50% MIS lobectomies) and analysis using multivariate logistic regression.
- Evaluation of the association between MIS utilization proportion and 90-day mortality, hospital length of stay, and readmission.
Main Results:
- The presence of surgical robots (OR 3.48) and increasing time (OR 1.26) were independently associated with facilities being high utilizers of MIS.
- High MIS utilization was linked to decreased 90-day mortality (OR 0.89) and shorter hospital stays (coefficient -0.88).
- Hospital readmission rates were comparable between high and low MIS-utilizing facilities (OR 1.06).
Conclusions:
- Surgical robots and temporal trends are key drivers for increased adoption of minimally invasive lung lobectomy.
- Robotic surgery is correlated with a higher proportion of MIS procedures and is associated with improved patient outcomes.
