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Robotic-assisted Pneumonectomy: A Comparison Between Totally-portal Robotic And Robotic Converted To Open Approaches
Daniel Zarif, Donna Bahroloomi, Paul Lee, Byron Patton, Richard Lazzaro.
Lenox Hill Hospital, New York, NY, USA.
BACKGROUND: In the tide of robotic-assisted minimally invasive surgery, few cases of robotic assisted pneumonectomy exist in the literature. This study is one of the first to evaluate the safety and feasibility of a robotic approach to pneumonectomy and to compare perioperative outcomes and morbidity of procedures completed robotically versus those converted to thoracotomy.
METHODS: The effect of robotic pneumonectomy on perioperative outcomes was assessed in a single-center study by evaluating 12 patients undergoing robotic pneumonectomy for lung cancer between 2015-2019: 7 patients underwent a completely robotic procedure and 5 patients were converted from robotic to open approach
RESULTS: Twelve patients underwent robotic pneumonectomy, 7 (58%) were completed robotically, and 5 (42%) were converted to open procedures for completion. The open completion group had a significantly higher DLCO, with no difference in FEV1 or other preoperative characteristics. The conversion rate decreased over time, with 60% of conversions occurring prior to 2017 (p<.01). The length of procedure (P<.001) and estimated blood loss (P<.02) were both significantly higher in the open conversion group. The number of lymph nodes obtained were significantly higher in the robotic completion group, with an average of 28.8 nodes compared to 18.6 lymph nodes in the open conversion group, (p<.02). There was no significant difference in histological diagnosis or lesion size between the two groups. All decisions for conversion were made electively during the case in nonurgent matter. 60% of patients were converted to open due to difficult anatomical visualization and dissection, one (20%) for esophageal adherence of mass, and one (20%) for dehiscence of bronchial staple line noted on completion. None of the conversions were made for bleeding or hemorrhage. The open conversion group had a significantly larger percentage of infectious bronchopulmonary complications when compared with the robotic completion group (p<.05). No other significant difference in perioperative morbidity were demonstrated.
CONCLUSIONS: Robotic pneumonectomy is a safe and feasible approach to oncologic resection in the appropriate patient and surgical experience with potential to enhance oncologic staging and outcomes. 
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