Objective: The use of robotic technology in lung cancer surgery has not been extensively reported. The objective of this pilot series was to assess the feasibility and safety of robotic-assisted lung resection for treatment of malignant lung lesions.
Methods: Between 9/04 and 11/06, 21 patients (male= 11, female = 10), with a median age of 65 years (range: 36-86) and ASA score of 3 (range: 3-4), underwent robotic lung resection for malignant disease and were retrospectively analyzed. Eighteen resections were performed for primary non-small-cell-lung cancers, 2 for metastatic lesions and 2 for carcinoid tumors. No patients were treated with preoperative chemoradiation therapy. One patient had bilateral resections for two primary tumors. Fourteen lobectomies, 6 segementectomies or wedge resections, and 2 bilobectomies were performed. 72% of operative procedures included mediastinoscopy and/or bronchoscopy at the time of resection. Operative times include all procedures performed.
Results: All procedures were successfully completely robotically with a postoperative mortality of 0%. The median operating room time and estimated blood loss was 217 mins (range: 55-387) and 100 ml (range: 20-600) respectively. The overall postoperative complication rate was 28%, which included atrial fibrillation, need for postoperative bronchoscopy, and empyema requiring operative drainage. Median number of ICU days and total length of hospital stay was 2 and 4 respectively. Chest tubes were removed after a median of 2.5 days (range: 1-5). Oncologic evaluation demonstrated the median number of lymph nodes harvested was 10 (range: 2-54), and there were no positive resection margins. Of the patients with primary lung cancers, 9 had Stage IA disease, 8 had Stage IB and 1 had Stage IIB. 41% of patients received adjuvant chemotherapy. Median follow-up time was 7 months (range: 2-25), with no local recurrence at this time.
Conclusions: Minimally invasive lung resections for malignant disease performed using robotic technology is safe and feasible and allows for adequate lymph node retrieval. Our preliminary results suggest that this novel technique offers short hospital stays and low morbidity for patients undergoing surgical resection of lung malignancies. Future studies will be necessary to better define the role of robotic surgery in lung cancer treatment.