Review of Outcomes Between Robotic and Thoracoscopic Thoracic Surgery: A Retrospective Cohort Study

Surgical management of lung cancer has evolved over the last two decades from open thoracotomy to video-assisted thoracoscopic surgery (VATS) and, more recently, robotic-assisted thoracoscopic surgery (RATS). We present our initial experience with RATS and hypothesize that overall outcomes will be improved compared to VATS and will result in overall cost savings.

A retrospective review of prospectively collected data was conducted on all patients who underwent RATS over the first year and a half since robotic surgery was introduced, compared to VATS over the two years prior to the initiation of robotic surgery in our institution. Demographics, operative, and postoperative data were obtained, and statistical analysis was performed using a t-test.

Patients undergoing RATS (n = 42) were older (70.31 +/- 8.89 vs. 64.64 +/- 12.53, p = 0.018) compared to the VATS group (n = 48). RATS operative times were longer, 190.26 minutes compared to 127.84 minutes (P=0.001) in the VATS group. Estimated blood loss (EBL) was significantly lower in the RATS group (74 ml versus 208 ml; p < 0.05). The mean length of stay was shorter in the RATS group (3.88 versus 6.22 days; p < 0.05). All postoperative outcomes were similar, including complications and 30-day mortality (RATS, 2.1%, versus VATS, 4.2%; p > 0.05). There were no statistical differences in length of intensive care unit (ICU) stay (0.3 versus 1.2 days; p > 0.05) or number of lymph nodes harvested (4.21 versus 3.81; p > 0.05).

RATS is safe and technically feasible, and short-term outcomes are comparable to those of the conventional VATS approach.