Thymectomy: The Early Learning Curve With Robotic Assisted Thoracoscopic Surgery
Faisal Alshlahi1, Iain McPherson2, Rohith Govindraj2, John Butler2, Alan Kirk2.
1University of Glasgow, Glasgow, United Kingdom, 2Golden Jubilee National Hospital, Glasgow, United Kingdom.
Background- Thoracic surgery has seen a significant increase in the use of robotic assisted thoracoscopic surgery (RATS) with an aim to replace current video-assisted thoracoscopic surgery (VATS). Thymectomy is a common procedure used in the early stages of RATS training to introduce surgeons to the robotic method. The aim of this project is to evaluate the early learning curve of RATS compared with VATS for thymectomy and its impact on length of stay. Methods- Data was prospectively collected between 2015 and 2018 for all VATS and RATS thymectomy cases completed in a tertiary thoracic centre. Baseline patient characteristics, operating times and length of stay were recorded in the chronological order of date of surgery. All cases that were converted to sternotomy were discounted from analysis. Median (IQR) operating times were calculated and linear regression analysis completed to assess correlation between operating times and days from first procedure for RATS cases, initial VATS cases, VATS cases performed by the robotic surgeons and all VATS cases performed in the centre. Mann-Whitney U test was used to compare length of stay between RATS and VATS. p<0.05 was considered significant. Results- There was a total of 41 thymectomies performed comprising of 31 VATS and 10 RATS procedures. The median operating time for all VATS thymectomies (n=31) was 137 (56) minutes (r2=-0.1004, p=0.0825). For the surgeons now performing RATS thymectomy, the median VATS operating time (n=21) was 133 minutes (55.5) (r2=-0.111, p=0.1399) with the median time for their first 10 VATS thymectomies 147 minutes (63.8) (r2=-0.2855, p=0.1116). RATS thymectomy operation times had a median of 136.5 minutes (47.8) (r2=-0.2224, p=0.1688) and have crossed the median operating time for all VATS thymectomies performed in the centre. Mean length of stay was 2 days in RATS thymectomy and 4 days in VATS thymectomy (p=0.006). Conclusions- Transfer of the surgical skills of thymectomy from video-assisted to robotic-assisted surgery helps surgeons achieve similar initial learning curves and may explain the reduced operating times in early RATS thymectomy. The benefit in reduction of length of stay supports the adoption of RATS in other aspiring thoracic centres. 
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