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J Thorac Cardiovasc Surg 2006;131:54-59
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Robotic assistance for video-assisted thoracic surgical lobectomy: Technique and initial results

Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Read at the 2004 Annual Meeting of The Society of Thoracic Surgeons.

Received for publication March 16, 2005; revisions received July 26, 2005; accepted for publication July 29, 2005.

^_* Address for reprints: Bernard J. Park, MD, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-867, New York, NY 10021. (Email: parkb{at}mskcc.org).

OBJECTIVES: There is little experience with telerobotic assistance for video-assisted thoracic surgical lobectomy. We developed a technique for robotic assistance during video-assisted thoracic surgical lobectomy and report our initial results.

METHODS: Video-assisted thoracic surgical lobectomy with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, Calif) was attempted in 34 patients (median age, 69.0 years; age range, 12-85 years). Robotic instruments were used for individual dissection of the hilar structures through 2 thoracoscopic ports and a 4-cm utility incision without rib spreading. Data on patient characteristics and perioperative results were collected prospectively.

RESULTS: Robot-assisted video-assisted thoracic surgical lobectomy was accomplished in 30 patients (19 female and 11 male patients). Every type of lobectomy was performed. Four (4/34 [12%]) patients required conversion to thoracotomy. The majority of patients had non–small cell lung cancer (32/34 [94%]), and 1 patient each had a typical carcinoid tumor and an extranodal B-cell lymphoma. Every patient underwent an R0 resection. The median number of lymph node stations dissected with robotic assistance was 4 (range, 2-7). Operative mortality was 0%, with no in-hospital or perioperative deaths. Nine (26%) patients experienced National Cancer Institute Common Toxicity Criteria for Adverse Events version 3.0 grade 2 or 3 complications. The median chest tube duration was 3.0 days (range, 2-12 days), and the median length of stay was 4.5 days (range, 2-14 days). The median operative time was 218 minutes (range, 155-350 minutes).

CONCLUSIONS: Robot assistance for video-assisted thoracic surgical lobectomy is feasible and safe. The utility and advantages of robotic assistance for video-assisted thoracic surgical lobectomy require further refinement and study of the technique.

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Thomas A. D'Amico
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