Developing a robotic program in thoracic surgery at Cape Cod Hospital.

This study aimed to elucidate the stepwise progression of robotic skills required, the natural progression from thoracoscopic to robotic technique with a focus on approaching the hilar structures, and the nuances of perioperative care, in a community hospital and solo surgeon practice. It was a case-control analysis comparing 22 consecutive robotic-assisted lobectomy (RAL) procedures with 22 matched historic video-assisted lobectomy (VAL) procedures from June 2011 to December 2012. Patients undergoing VAL had 1.09 days greater length of stay than did patients who underwent RAL. Although hospital charges were significantly higher for RAL patients, patients undergoing VAL had greater blood loss, required longer hospital stay, had greater readmission rates, and were transferred more often to a rehabilitation facility at discharge. Subjectively, dexterity, ergonomics, and optics with the RALs were superior to the VALs. Favorable outcomes were demonstrated for patients undergoing RALs. Effective communication is paramount for the skill set and team building for a safe transition to practice.