Objective: We analysed the feasibility and safety of robotic approach for the treatment of early stage lung cancer with standard lobectomy and describe the technique of robotic assisted lobectomy (RAL)and mediastinal lymph node dissection (MLD). Methods: During a 21 months period (Dec 2006-Sept 2008), 54 patients underwent RAL for early stage lung cancer at our Institute. The approach included three ports and one utility incision. Dissection and isolation of the hilar structures was performed using the four arms Da Vinci System. Vascular and bronchial resections were done with the use of standard endoscopic staplers. Standard MLD was performed after completion of the lobectomy. The 54 patients were individually matched for age (± 5 years), sex, stage, nodal status and forced expiratory ventilation in 1 sec with patients who underwent open lobectomy in the same institute during the same period and were divided into three series based on the learning curve according to duration of surgery. Results: In 7 patients (13%) conversion from RAL to open surgery was necessary because of absence of fissure in 5, oncological reason and anatomical reason of the chest in each one. The number of overall postoperative complications (20%, p=0.88) and the mean number of lymph nodes removed (18.1 ± 7.9 in open versus 16.8 ± 7.5 in RAL, p=0.43) were similar in both groups. The median time for RAL decreased by 52 minutes between the first and the last two series of interventions (p=0.01). The median length of post-operative stay was significantly shorter after RAL than after open interventions (4.5 days robotic in the third series vs. 6 days open, p=0.006). Conclusion: RAL with MLD is a feasible and safe procedure. It is an acceptable treatment for early stage lung cancer with equal results to open surgery during the early postoperative course. The benefit in terms of postoperative pain, respiratory function and quality of life are under evaluation in a prospective case control study and oncological long term results will be evaluated.
Robotic Lobectomy for the Treatment of Early Stage Lung Cancer / G. Veronesi, F. Melfi, D. Galetta, R.A. Schmid, P. Maisonneuve, N. Rotmensz, F. Vannucci, R. Bertolotti, L. Spaggiari. ((Intervento presentato al 89. convegno AATS annual meeting tenutosi a Boston, USA nel 2009.
Robotic Lobectomy for the Treatment of Early Stage Lung Cancer
D. Galetta;L. Spaggiari
2009
Abstract
Objective: We analysed the feasibility and safety of robotic approach for the treatment of early stage lung cancer with standard lobectomy and describe the technique of robotic assisted lobectomy (RAL)and mediastinal lymph node dissection (MLD). Methods: During a 21 months period (Dec 2006-Sept 2008), 54 patients underwent RAL for early stage lung cancer at our Institute. The approach included three ports and one utility incision. Dissection and isolation of the hilar structures was performed using the four arms Da Vinci System. Vascular and bronchial resections were done with the use of standard endoscopic staplers. Standard MLD was performed after completion of the lobectomy. The 54 patients were individually matched for age (± 5 years), sex, stage, nodal status and forced expiratory ventilation in 1 sec with patients who underwent open lobectomy in the same institute during the same period and were divided into three series based on the learning curve according to duration of surgery. Results: In 7 patients (13%) conversion from RAL to open surgery was necessary because of absence of fissure in 5, oncological reason and anatomical reason of the chest in each one. The number of overall postoperative complications (20%, p=0.88) and the mean number of lymph nodes removed (18.1 ± 7.9 in open versus 16.8 ± 7.5 in RAL, p=0.43) were similar in both groups. The median time for RAL decreased by 52 minutes between the first and the last two series of interventions (p=0.01). The median length of post-operative stay was significantly shorter after RAL than after open interventions (4.5 days robotic in the third series vs. 6 days open, p=0.006). Conclusion: RAL with MLD is a feasible and safe procedure. It is an acceptable treatment for early stage lung cancer with equal results to open surgery during the early postoperative course. The benefit in terms of postoperative pain, respiratory function and quality of life are under evaluation in a prospective case control study and oncological long term results will be evaluated.
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