Outcomes of Robotic Surgery for Patients with Pulmonary Nontuberculous Mycobacterial Disease

Abstract

Background: Treatment for patients with pulmonary nontuberculous mycobacterial (NTM) disease includes long, multi-drug, and toxic medication regimens. Surgical resection is an alternative treatment for patients with localized or refractory NTM infection. Robot-assisted operations have not been performed routinely in this population. Methods: A retrospective review was performed on patients with NTM disease that underwent robotic anatomic pulmonary resection at NYU Langone Medical Center between August 2017 and May 2021. Results: A total of 12 patients underwent 13 operations. The majority of patients were female (92%) and white (83%). Mean age at time of surgery was 61 years. The most common indication for surgery was cavitary disease, followed by failure of medical therapy, and hemoptysis. All patients had pre-operative sputum cultures positive for Mycobacterium avium intracellulare . 67% of patients were on IV antibiotics prior to surgery. Lobectomy was the most common operation performed. There were no post-operative deaths. Three patients had a prolonged air leak (> 5 days). There were no post-operative bleeds requiring transfusion, pneumonias, pneumothoraces, or bronchopleural fistulas. None of the patients required an ICU stay and the median length of hospital stay was 1 day. Ten patients were followed for a median follow-up period of 21 months (range 6-48 months). Seven patients have been followed for over a year and are no longer on antibiotic therapy. The remaining three patients had recent surgeries and have de-escalated their medical regimen and are off IV therapy. Interpretation: Surgical resection for patients with complex NTM disease can be performed using minimally invasive, robotic techniques safely and without the need for conversion to open thoracotomy, blood transfusions, or ICU stay. In this small cohort of patients, robotic surgery had a high rate of cure, few post-operative complications, and a short length of hospital stay.