Establishing a robotically assisted lung cancer surgery program in a low-volume center: Does a surgeon's previous experience with video-assisted thoracoscopy affect short-term outcomes?

Background and aims: The aim of this study was to compare the safety and efficacy of establishing a robotic-assisted thoracoscopic surgery (RATS) program in a low-volume center with mixed cardiothoracic practice and surgeons with different background experiences-video-assisted (VA) versus open thoracotomy (OT).

Methods: Between January 2015 and June 2023, the center performed 460 anatomical lung resections. The RATS program was established in October 2021, and two surgeons, OT and VA, were selected as RATS surgeons. Before this, surgeon OT performed mostly open thoracic surgery, and surgeon VA had notably more thoracoscopic experience. The primary outcomes were the learning curves of surgeon OT and VA for lymph node yield, operative time, blood loss, and complications after starting the RATS program. A Risk-Adjusted Cumulative Sum (RA-CUSUM) method was used to determine learning curves.

Results: Surgeons OT and VA showed similar learning curves in lymph node yield with surgeon OT having a peak at case number 23 and surgeon VA at 19. Operative time improved with surgeon VA after 15 cases and with surgeon OT after 30 cases. RA-CUSUM analysis showed no increased bleeding cases when comparing the baseline risk and the median bleeding values of the center. With both surgeons, there were significantly fewer overall complications when using RATS than with other surgical techniques.

Conclusion: According to this study, training surgeons with either open or thoracoscopic background experience to perform robotic-assisted lung cancer surgery is safe and does not compromise short-term operative outcomes. This study is a retrospective registry study and has been approved by the Northern Ostrobothnia Research Ethics Committee with license number EETTMK 5/2019; hence, no clinical trial registry number is associated with this study.