kenneth A. lee.
Anne Arundel Medical center, Annapolis, MD, USA.
OBJECTIVE:
Lung cancer is the leading cause of cancer related deaths. The earliest lobectomies were described as a mass ligation procedure. The pulmonary lobectomy became the procedure of choice in 1950. The 1990s heralded the minimal invasive surgery (MIS) approach utilizing video assisted thoracoscopic surgery (VATS). A multi-institutional review of VATS lobectomy concluded the operation was safe with similar survival rates performed through thoracotomy. Complete versus assisted thorascopic lobectomies for stage I lung cancers, showed no significant differences in analgesia requirements but shorter length of stay in the purely endoscopic approach with preservation of the immune system. Disadvantages associated with VATS are limited visualization and maneuverability of instrumentation. The da Vinci robot (Intuitive Surgery, Sunnyvale, CA) with the introduction of the fourth arm; redefines the VATS lobectomy, by overcoming these limitations.
METHODS:
62 consecutive pulmonary lobectomies utilizing a four-
armed da Vinci robot were prospectively studied. Setup and operative times, extubation time, length of hospital stay, and complications were archived.
RESULTS:
Population included 25 males and 37 females (mean age 65
years). Indications were early-stage non-small cell lung cancer in 53 patients, 4
metastatic , 2 small cell, 3 benign lesions. Operative procedures included 6 RUL, 2
RU/ML, 7 RML, 21 RLL, 13 LUL and 13 LLL. No operative mortality. Set-up time
averaged 25 minutes. Operative time 172 minutes. Complications
included air leaks, atrial fibrillation, and colitis. All patients were extubated in the
operating room. Length of stay was one to two days 28 patients (45%), within three
days 37 patients (60%), and 51 patients (82%) were discharged within 5 days.
CONCLUSIONS:
VATS and the introduction of computer-assisted surgical endoscopic procedures has resulted in a shift in management of thoracic pathology. The four arm robotic approach is safe and less diminishing than conventional thoracotomy. Anatomical planes and oncologic principles are maintained in the robotic approach. Length of stay are improved compared to a thoracotomy. The enhancement of VATS lobectomy using the da Vinci four-armed robot provides the thoracic surgeon with the same wrist action and two handed dexterity as in a thoracotomy procedure as well as three dimensional visualization.
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