A Precision Surgery Framework for Lung Resection: Robotic, Video-Assisted, and Open Segmentectomy

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Lung segmentectomy is a surgical procedure to remove a segment of the lung.
• Surgical approaches include open thoracotomy, Video-Assisted Thoracoscopic Surgery (VATS), and Robotic-Assisted Thoracoscopic Surgery (RATS).
• Comparative outcome data for these approaches in segmentectomy are crucial for clinical decision-making.

Purpose of the Study:

• To compare peri-operative and long-term outcomes of lung segmentectomy across open thoracotomy, VATS, and RATS.
• To evaluate the efficacy and safety of minimally invasive approaches (VATS, RATS) versus open surgery.

Main Methods:

• Retrospective analysis of 157 patients undergoing lung segmentectomy (2015-2024).
• Patients were grouped by surgical approach: thoracotomy (n=60), VATS (n=58), RATS (n=39).
• Peri-operative and long-term outcomes (including survival in non-small cell lung cancer patients) were analyzed and compared using statistical tests.

Main Results:

• RATS had a 0% conversion rate versus 13% for VATS (p=0.005).
• RATS demonstrated lower post-operative pleural effusion and pain (VAS) compared to VATS and open thoracotomy.
• While RATS surgery time was longer, RATS and VATS showed improved 90-day mortality and 1-2 year overall survival compared to thoracotomy (p<0.05).
• More lymph node stations were harvested in RATS and open approaches than VATS.

Conclusions:

• RATS segmentectomy offers advantages over VATS, including lower conversion rates, reduced pain, and less pleural effusion.
• Both RATS and VATS segmentectomy provide superior short- and long-term survival outcomes compared to open thoracotomy.
• Minimally invasive techniques are favorable for lung segmentectomy, particularly for oncological outcomes.