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Original Articles: General Thoracic

Robot-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer

Washington Institute of Thoracic and Cardiovascular Surgery, George Washington University Medical Center, Washington, DC

Accepted for publication February 27, 2008.

^_* Address correspondence to Dr Gharagozloo, Washington Institute of Thoracic and Cardiovascular Surgery, 2175 K St NW, Washington, DC 20037 (Email: gharagozloo{at}aol.com).

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

Background: Video-assisted thoracic surgery lobectomy is an accepted oncologic procedure for patients with early-stage lung cancer. We studied the use of the da Vinci surgical robot for mediastinal, hilar, and vascular dissection during video-assisted thoracic surgery lobectomy in patients with early-stage lung cancer.

Methods: During a 41-month-period, 61 patients (27 men, 34 women; mean age, 68.2 years) underwent a robot-assisted video-assisted thoracic surgery lobectomy and complete mediastinal nodal dissection for early-stage lung cancer (stages I, II).

Results: Distribution of lobectomies was right upper lobe 14, right middle lobe 6, right lower lobe 9, left upper lobe 21, and left lower lobe 11. Operative times ranged from 3 to 6 hours (median, 4). There were 34 adenocarcinoma, 14 squamous cell carcinoma, 6 adenosquamous, 1 large cell, 2 bronchoalveolar, 2 poorly differentiated cancers, and 2 carcinoid tumors. Pathologic upstaging was noted in 10 patients (8 to IIb, 2 to IIIa). There were no emergent conversions to a thoracotomy. Complications included atrial fibrillation (4), atelectasis (4), prolonged air leak (2), pleural effusion (2), hydropneumothorax (1), and incisional bleeding (1). Mortality was 4.9%. Median hospitalization was 4 days. Follow-up was complete in 54 patients (88%). At a mean follow-up of 28 months, all patients were alive, and 4 had distant metastases. There was no local recurrence.

Conclusions: Robot-assisted vascular and nodal dissection during video-assisted thoracic surgery lobectomy for early-stage lung cancer is feasible. Greater experience and long-term follow-up is required to better evaluate patient selection, oncologic efficacy, and comparability with a conventional open approach.