Experience with robotic lobectomy for lung cancer.

OBJECTIVE

In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation.

METHODS

Ninety-one patients with suspected or proven clinical stage I-III lung cancer underwent robotic lobectomy. Selection criteria included lesion <5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy.

RESULTS

Median duration of operation was 239 (range 85-411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P=0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P=0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease.

CONCLUSIONS

Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery.