Robotic anatomic pulmonary resection in octogenarian patients with primary lung cancer: report of seven cases

WOS: 000385272300012Background: This article aims to report our experience with robotic anatomic pulmonary resections in primary lung cancer patients aged 80 years and older and to compare the results with a younger patient population. Methods: Data of 75 patients who were performed robotic anatomic pulmonary resection in our clinic between October 2011 and January 2015 for primary lung cancer were retrospectively evaluated. Patients were divided into two groups as patients aged 80 years and older (octogenarians, n=7) (6 males, 1 female; mean age 82.0 +/- 1.8 years; range 80 to 84 years) and patients aged below 80 years (non-octogenarians, n=68) (51 males, 17 females; mean age 61 +/- 11 years; range 31 to 79 years) and the obtained results were compared. Results: Four lobectomies and three segmentectomies were performed in the seven octogenarian patients. Mean docking, console, and total operation durations were 21 +/- 12, 75 +/- 10 minutes, and 101 +/- 20, respectively. Mean duration of hospital stay was 6 +/- 4 days. There was no mortality, but minor complications occurred in two patients (29%). Although octogenarians had lower pulmonary function test results and longer durations of chest tube and hospital stay, their resection types, operation durations, resected lymph node numbers, size of lesions, mortality and morbidity rates were similar compared to those of non-octogenarians. Conclusion: This preliminary study demonstrates that postoperative outcomes of octogenarians who underwent robotic anatomic pulmonary resection were similar to those of younger patients. Anatomical pulmonary resections with robotic approach may be performed in carefully selected octogenarian patients with primary lung tumor who may tolerate the operation and complete resection

Robotic lung segmentectomy for malignant and benign lesions

WOS: 000342339200014PubMed ID: 25093090Objective: Surgical use of robots has evolved over the last 10 years. However, the academic experience with robotic lung segmentectomy remains limited. We aimed to analyze our lung segmentectomy experience with robot-assisted thoracoscopic surgery. Methods: Prospectively recorded clinical data of 21 patients who underwent robotic lung anatomic segmentectomy with robot-assisted thoracoscopic surgery were retrospectively reviewed. All cases were done using the da Vinci System. A three incision portal technique with a 3 cm utility incision in the posterior 10th to 11th intercostal space was performed. Individual dissection, ligation and division of the hilar structures were performed. Systematic mediastinal lymph node dissection or sampling was performed in 15 patients either with primary or secondary metastatic cancers. Results: Fifteen patients (75%) were operated on for malignant lung diseases. Conversion to open surgery was not necessary. Postoperative complications occurred in four patients. Mean console robotic operating time was 84 +/- 26 (range, 40-150) minutes. Mean duration of chest tube drainage and mean postoperative hospital stay were 3 +/- 2.1 (range, 1-10) and 4 +/- 1.4 (range, 2-7) days respectively. The mean number of mediastinal stations and number of dissected lymph nodes were 4.2 and 14.3 (range, 2-21) from mediastinal and 8.1 (range, 2-19) nodes from hilar and interlobar stations respectively. Conclusions: Robot-assisted thoracoscopic segmentectomy for malignant and benign lesions appears to be practical, safe, and associated with few complications and short postoperative hospitalization. Lymph node removal also appears oncologically acceptable for early lung cancer patients. Benefits in terms of postoperative pain, respiratory function, and quality of life needs a comparative, prospective series particularly with video-assisted thoracoscopic surgery

Robotic lung segmentectomy for malignant and benign lesions

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Objective: Surgical use of robots has evolved over the last 10 years. However, the academic experience with robotic lung segmentectomy remains limited. We aimed to analyze our lung segmentectomy experience with robot-assisted thoracoscopic surgery. Methods: Prospectively recorded clinical data of 21 patients who underwent robotic lung anatomic segmentectomy with robot-assisted thoracoscopic surgery were retrospectively reviewed. All cases were done using the da Vinci System. A three incision portal technique with a 3 cm utility incision in the posterior 10th to 11th intercostal space was performed. Individual dissection, ligation and division of the hilar structures were performed. Systematic mediastinal lymph node dissection or sampling was performed in 15 patients either with primary or secondary metastatic cancers. Results: Fifteen patients (75%) were operated on for malignant lung diseases. Conversion to open surgery was not necessary. Postoperative complications occurred in four patients. Mean console robotic operating time was 84 +/- 26 (range, 40-150) minutes. Mean duration of chest tube drainage and mean postoperative hospital stay were 3 +/- 2.1 (range, 1-10) and 4 +/- 1.4 (range, 2-7) days respectively. The mean number of mediastinal stations and number of dissected lymph nodes were 4.2 and 14.3 (range, 2-21) from mediastinal and 8.1 (range, 2-19) nodes from hilar and interlobar stations respectively. Conclusions: Robot-assisted thoracoscopic segmentectomy for malignant and benign lesions appears to be practical, safe, and associated with few complications and short postoperative hospitalization. Lymph node removal also appears oncologically acceptable for early lung cancer patients. Benefits in terms of postoperative pain, respiratory function, and quality of life needs a comparative, prospective series particularly with video-assisted thoracoscopic surgery

Lymph node dissection in surgery for lung cancer: Comparison of open vs. video-assisted vs. robotic-assisted approaches

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Purpose: We compared open, video-assisted and robotic-assisted thoracoscopic surgical techniques in the dissection of N1 and N2-level lymph nodes during surgery for lung cancer. Methods: This retrospective analysis is based on prospectively collected data of patients (excluding those with N2 or N3 diseases, and sleeve resections) undergoing mediastinal lymph node dissection via open (n = 96), video-assisted thoracoscopy (n = 68), and robotic-assisted thoracoscopy (n = 106). The groups are compared according to the number of lymph node stations dissected, the number of lymph nodes dissected, and the number of lymph nodes dissected by stations. Results: Three techniques had similar results based on the number of the dissected N1 and N2-level lymph node stations. Robotic-assisted thoracoscopic surgery yielded significantly more lymph nodes in total (p = 0.0007), and in the number of dissected N1-level nodes (p <0.0001). All techniques yielded similar number of mediastinal lymph nodes, whereas robotic-assisted thoracic surgery (RATS) yielded more station #11 and #12 lymph nodes compared to the other groups. Conclusions: In this study, robotic-assisted thoracoscopic surgery has been shown to dissect more lymph nodes at N1 level. However, taking the open approach as standard, we could claim that both currently robotic and video-assisted techniques may provide similar number of dissected N1 and N2-level lymph node stations