In A Cardiothoracic Training Program, How Does Robotic Pulmonary Lobectomy Compare With Thoracotomy And VATS Lobectomy: A 6-year Analysis?
James T. Nawalaniec, Matthew Elson, Scott Reznik, Michael Wait, Matthias Peltz, Michael Jessen, Chaofan Yuan, Alejandra Madrigales, Jerzy Lysikowski, Kemp H. Kernstine.
University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
OBJECTIVE: Our understanding of robotic lobectomy is largely from established thoracic surgical programs with experienced teams without trainee involvement. Our objective is to assess the effect of robotic lobectomy on patient care, CT training, and on the health-care system.
METHODS: From a prospectively maintained database of anatomic lung resections from 1/1/2006 to 6/30/2016, clinical data was obtained. From the analytics department and tumor registry, respectively, cost and oncologic data was collected. Based on age, sex, and five comorbidities, propensity scores were assigned. Differences were confirmed using multiple regression analysis. Survival was analyzed by the Kaplan-Meier method and compared to the SEER database. Our robotic CT training method consists of a 6-month program over 3 years; the first 3 months focus on simulation and bedside-assist and the last 3 months, on complete case set-up and console training.
RESULTS: 523 consecutive cases were identified, 91 cases were excluded. The query identified 212 robotic (179 non-small cell lung cancer (NSCLC)), 160 thoracotomy (117 NSCLC) and 60 video-assisted (VATS) (44 NSCLC) cases. Multiple surgeons performed each approach. Operative results, and clinical and oncologic outcomes, favored robotic surgery compared to thoracotomy and showed little difference with VATS (Table 1). A CT resident served as the console surgeon in 35% of all cases: 0% in the first two years increasing to 79% in the latest year. Minimally invasive surgeries increased from 32% of all cases in the first year of robotics to 89% in the latest year. The total volume of lung cancer increased by 51%, surgical cases by 92%, and clinical trial accrual by 70%.
CONCLUSIONS: In the setting of a CT training program, robotic lobectomy can be performed without sacrificing quality. Robotic surgery in this setting offers similar or better clinical results, is cost-effective, and is oncologically-sound. Additionally, a robotic program may increase an institution’s lung cancer volume, enhancing resident training and clinical research. Finally, this analysis has identified opportunities to improve efficiency and reduce cost.
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