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Implementation of a robot-assisted thoracic surgery program at a German center: analysis of the first 100 consecutive
Ulukan Cenal1, Ahmad Rami Diwan1, Volkan Kösek1
1Department of Thoracic Surgery, Knappschaft Kliniken Lünen, Lünen, Germany.
Background:
Robot-assisted thoracic surgery (RATS) is increasingly being implemented in Europe, but data on the early institutional adoption and integration of RATS programs in Germany remain limited. This study describes the implementation of a RATS program at a German thoracic surgery center and evaluates operative characteristics, procedural safety, and temporal changes during the first 100 consecutive cases.
Methods:
This retrospective study included 100 consecutive RATS procedures performed between July 2024 and January 2025. Procedures included lobectomies, segmentectomies, bisegmentectomies, trisegmentectomies, wedge resections [diagnostic, lung-volume-reduction surgery (LVRS) and pneumothorax], and mediastinal tumor resections. Cumulative sum (CUSUM) analysis was used as an exploratory tool to assess temporal changes in total operative time, console time, and docking time during program implementation. Phase comparisons were performed using the Mann-Whitney U test.
Results:
The 100 patients had a median age of 70 years (range, 39-87 years); 58% were male. Median total operative time was 100 min, median console time 80 min, and median docking time 12 min. The conversion rate was 5.0% and the intraoperative complication rate 3.0%. CUSUM analysis demonstrated a temporal inflection point around case 36 for total operative time and around case 31 for docking time. Docking time decreased significantly from Phase I to Phase II (median 15.5 vs. 11.0 min; P<0.001), and estimated blood loss also decreased significantly (median 50 vs. 30 mL; P=0.006). A significant downward trend was observed for docking time across all cases (Spearman rho =-0.559, P<0.001).
Conclusions:
The first 100 consecutive RATS procedures at our institution demonstrate that implementation of a robotic thoracic surgery program in a German thoracic surgery center is feasible and can be performed with acceptable operative outcomes, a low conversion rate, and a low incidence of intraoperative complications. Temporal improvements were observed particularly in docking performance, suggesting progressive team-based adaptation to the robotic workflow. Because of procedural heterogeneity and the exploratory nature of the analysis, the present findings should be interpreted primarily as an evaluation of program implementation rather than as a definitive determination of a learning threshold.
