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Objectives:
Minimal access Thoracic Surgery is a relatively new speciality in India. With adequate experience of VATS Thoracic Surgery, we set out to establish a Robotic Thoracic Surgery programme in India. We present our trials and tribulations encountered during this process.
Materials & Methods:
20 consecutive patients underwent robotic thoracic surgery over a period of 3 months (July 2011 to December 2011). The inclusion criteria included all patients suitable for VATS surgery was offered the option for robotic resection. The patient who refused robotic surgery were the ones who could not afford the extra cost. These were operated by VATS.
Results:
The mean age was 53 years (range 18 years to 88 years).
The surgery performed by Da Vinci Si 4 arm robot included:
Right upper Lobectomy
Right Middle lobectomy
Right lower lobectomy
Left Upper lobectomy
Left lower lobectomy
Resection of Thoracic Outlet Tumour
Robotic Thymectomy for Myaesthenia Gravis
Robotic Thymectomy for Thymoma / Thymic carcinoma
Robotic Posterior mediastinal Schwannoma resection
Robotic Resection of suspected Teratoma
Robotic Metastatectomy
Robotic Mediastinal Systematic Nodal Dissection
Robotic resection of aspergilloma
Drain was removed on first postoperative day after ensuring adequate lung expansion. One patient had air leak and required drain for 5 days. Patients were usually discharged on the following morning after drain removal. Mean Hospital stay was 3 days. One patient who underwent Thymectomy had evidence of right phrenic palsy which was resolving on follow up. One patient scheduled for robotic Thymectomy had a tension pneumothorax necessitating conversion to open.
Conclusions:
Robotic Thoracic Surgery is a additional option for performing minimally invasive thoracic surgery. There is a learning curve involved in docking and port placement. However, being an experience VATS Surgeon leads to improve hand eye coordination while operating on the console.