Outcome Following Initial Consecutive 271 Cases With Robotic-Assisted Thoracoscopic Surgery Using Complete Portal Technique
Yuan Kong1, Yue Li2, Fazuludeen Ali Akbar1, Atasha Binti Asmat1, Dokev Basheer Ahmed Aneez Ahmed1.
1Tan Tock Seng Hospital, Singapore, Singapore, 2National University Health System, Singapore, Singapore.
Background - We publish our 4-year experience in implementing a Robotic-Assisted Thoracoscopic Surgery (RATS) programme in a moderate-volume tertiary hospital, using complete portal technique based on the new consensus statement descriptors. Methods - We retrospectively reviewed our experience in starting a robotic programme in thoracic surgery on a consecutive series of patients from January 2013 to September 2017. Patient demographics and characteristics were analyzed. We also examined surgery time, length of stay, adverse events, death, and outcomes one year after surgery. Results - Between January 2013 and September 2017, 271 patients who underwent RATS were identified from the hospital database. 57.6% (n= 156) were lung resections, and 42.4% (n= 115) were mediastinal resections. Six cases were converted to open, mainly due to bleeding or difficult dissection with dense adhesion. The average blood loss were 91.5 (±17.4) ml, 110.0 (±15.2) for lung resections and 73.8 (±10.5) ml for mediastinal resections respectively. The median operative time for robotic mediastinal resection was 108 minutes, and median length of stay was 3 days. The median time for robotic lung resection was 123 minutes, and median length of stay was 4 days. The most common morbidities occurred: prolonged air leak (5.17%, n=14), bleeding (4.06%, n=11), infection (2.58%, n=7), and respiratory failure (1.48%, n=4). All patients with cancer had R0 resection and resection of all visible mediastinal and hilar lymph nodes. One year post surgery 93.4% (n= 253) patients are still alive. Those who are not, they have died of thoracic causes (n=10, metastatic disease, pneumonia and respiratory failure) and non-thoracic causes (n=8). Conclusions - RATS has many potential benefits to hand. Implementing a robotic thoracic surgical programme in Singapore is safe and feasible. Undeniably the learning curve is steep but proper training of residents is essential for safe implementation of this fairly new surgical method.
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