Massachusetts Chapter of the American College of Surgeons

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Evaluation of the Early Adoption Phase of Robotic Assisted Lung Resection in a Well-established Video Assisted Thoracic Surgery Practice
Ashley L. Deeb, MD1, Luis De Leon, MD1, Suden Kucukak, MD1, Emanuele Mazzola, PhD2, Michael T. Jaklitsch, MD1, Jon O. Wee, MD1, Matthew M. Rochefort, MD1
1Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; 2Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA

Reported advantages to robotic thoracic surgery include shorter length of stay (LOS), improved lymphadenectomy, and decreased complications. It is uncertain if these occur when introducing robotics into a well-established video-assisted thoracoscopy (VATS) practice. We compared the two approaches to investigate these advantages.

Segmentectomy or lobectomy patients from May 2016-December 2018 were propensity-matched 2:1 (VATS: robotic) using logistic regression with age, gender, Charlson Index, surgery type, stage, Exparel, and epidural as covariates. Complications, operation times, sampled lymph nodes, pain, disposition, and LOS were compared using Wilcoxon rank-sum and Rao-Scott tests.

213 patients (142 VATS and 71 robot) were matched. Robotic cases were longer than VATS (median 186 min (IQR 78) vs. 164 min (IQR 78.75); p<0.001). Significantly more nodes (median 11 (IQR 7.50) vs. 8 (IQR 7.00); p=0.004) and stations were sampled (median 4 (IQR 2.00) vs. 3 (IQR 1.00); p<0.001) with the robot. Robotic resections had higher 72-hour pain scores (median 3 (IQR 3.25) vs 2 (IQR 3.50); p=0.04) and 48 hour opioid usage (median 37.50 morphine milligram equivalents (MME) (IQR 45.50) vs 22.50 MME (IQR 37.50); p=0.01), perhaps from lower epidural use (16.90% vs 35.92%, p=0.01). Morbidity, LOS, and disposition were similar (all p>0.05).

The robotic approach facilitates lymph node sampling, even in an established VATS practice. Epidural utilization for appropriate robotic cases may be useful.

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