Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results.

Abstract

Minimally invasive video-assisted thoracic surgery (VATS) lobectomy has proven to be feasible and oncologically acceptable for non-small cell lung cancer (NSCLC) and a number of other conditions. Multiple studies have demonstrated clear benefits of VATs over a traditional thoracotomy approach, such as decreased length of stay, decreased short-term postoperative pain and fewer complications (1-4). Despite this, however, a VATS approach to anatomic resection is still not the current standard and is only slowly being implemented more widely. The explanation is likely multifactorial including: (I) technical issues, such as two-dimensional imaging and limited maneuverability of instrumentation; (II) lack of adequate training; and (III) concerns about the consequences of major vascular injury with a closed chest approach. In order to address the perceived technical limitations of conventional minimally invasive platforms a master-slave robotic surgical system was developed (da Vinci Surgical System, Intuitive Surgical, Sunnyvale, California). The major advantages were in the three-dimensional visual system that re-establishes binocular vision and instrumentation capable of seven degrees of freedom enabling wristed movement for dissection. The initial intent for this robotic system was for use in closed chest coronary surgery, but this has not eventuated. Instead, the major applications have been for pelvic procedures, such as prostatectomy and hysterectomy. Use of robotics for general thoracic surgical procedures dates back to initial case reports in the early 2000’s, but it was not until 2004 and 2006 that actual series of robotic lobectomies were reported by Melfi and colleagues and Park and coauthors, respectively (5,6). These centers reported the initial technique and experience demonstrating feasibility and concordance of outcomes with the largest series of VATS lobectomies. However, long-term data are lacking in a larger cohort of patients.