Andreas Westerlind, Maya Landenhed-Smith, Carl-Johan Malm, Göran Dellgren
{"title":"Implementation of a robotic-assisted thoracic surgery program for anatomical lung resections, a single surgeon's experience.","authors":"Andreas Westerlind, Maya Landenhed-Smith, Carl-Johan Malm, Göran Dellgren","doi":"10.21037/jtd-24-1182","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted thoracic surgery (RATS) for pulmonary resections has been reported to be a safe and feasible method with similar outcomes to those of video-assisted thoracic surgery (VATS). In 2021 our department launched a RATS program. The aims of this study are to evaluate the initial results and learning curve of a series of RATS procedures performed by a single surgeon experienced in uniportal video-assisted thoracic surgery (uVATS) during an initial period of access to the robotic platform limited to two cases per week.</p><p><strong>Methods: </strong>A retrospective study including consecutive RATS and uVATS lobectomies performed by a single surgeon from November 2021 to September 2023 at Sahlgrenska University Hospital. Endpoints were days with chest tube (CT), length of stay (LOS) and intraoperative learning curve as reflected in the duration of procedures.</p><p><strong>Results: </strong>A total of 82 RATS and 60 uVATS consecutive lobectomies were included. Preoperative demographics were similar in the RATS and uVATS groups. Preoperative assessment of tumour size from computed tomography scans were larger in the uVATS group than in the RATS group [25 (18.00-39.00) <i>vs.</i> 18 (14.00-28.25) mm, P=0.002], but clinical tumour-node-metastasis (TNM) stage were similar between groups (P=0.23). Days with CT was significantly shorter for RATS than uVATS [1.00 (1.00-1.00) <i>vs</i>. 1.00 (1.00-3.75)]; P=0.01]. LOS in the RATS group was 2 [2.00-3.00] <i>vs.</i> 2 [2.00-5.00] days in the uVATS group (P=0.07). Operation time (OP time) was longer in the RATS group [136.00 (114.50-152.25) <i>vs.</i> 100 (84.25-120.00) minutes in the uVATS group; P<0.001]. After RATS case number 44 no further reduction in OP time was recorded.</p><p><strong>Conclusions: </strong>RATS is a feasible method for lobectomy and can be efficiently introduced as a standard surgical approach even with limited access to the robotic surgical platform, with a learning curve of approximately 44 cases.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 3","pages":"1335-1348"},"PeriodicalIF":2.1000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986765/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-1182","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/20 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Robotic-assisted thoracic surgery (RATS) for pulmonary resections has been reported to be a safe and feasible method with similar outcomes to those of video-assisted thoracic surgery (VATS). In 2021 our department launched a RATS program. The aims of this study are to evaluate the initial results and learning curve of a series of RATS procedures performed by a single surgeon experienced in uniportal video-assisted thoracic surgery (uVATS) during an initial period of access to the robotic platform limited to two cases per week.
Methods: A retrospective study including consecutive RATS and uVATS lobectomies performed by a single surgeon from November 2021 to September 2023 at Sahlgrenska University Hospital. Endpoints were days with chest tube (CT), length of stay (LOS) and intraoperative learning curve as reflected in the duration of procedures.
Results: A total of 82 RATS and 60 uVATS consecutive lobectomies were included. Preoperative demographics were similar in the RATS and uVATS groups. Preoperative assessment of tumour size from computed tomography scans were larger in the uVATS group than in the RATS group [25 (18.00-39.00) vs. 18 (14.00-28.25) mm, P=0.002], but clinical tumour-node-metastasis (TNM) stage were similar between groups (P=0.23). Days with CT was significantly shorter for RATS than uVATS [1.00 (1.00-1.00) vs. 1.00 (1.00-3.75)]; P=0.01]. LOS in the RATS group was 2 [2.00-3.00] vs. 2 [2.00-5.00] days in the uVATS group (P=0.07). Operation time (OP time) was longer in the RATS group [136.00 (114.50-152.25) vs. 100 (84.25-120.00) minutes in the uVATS group; P<0.001]. After RATS case number 44 no further reduction in OP time was recorded.
Conclusions: RATS is a feasible method for lobectomy and can be efficiently introduced as a standard surgical approach even with limited access to the robotic surgical platform, with a learning curve of approximately 44 cases.
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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