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Robotic Bronchial Sleeve Resections: Outcomes From Transatlantic Experience
Alper Toker
1, Tugba Cosgun
2,
Berralp Aslan Arikan3, Xun Luo
4, Erkan Kaba
5, Vinay Badhwar
4, Jason Lamb Lamb
4.
1Istanbul Florence Nightingale Hospital-West Virginia University, Istanbul (Avr), Turkey,
2West Virginia University, Istanbul (Avr), Turkey,
3Istanbul Florence Nightingale Hospital-West Virginia University, I;stanbul (Avr), Turkey,
4West Virginia University, West Virginia, WV, USA,
5Istanbul Florence Nightingale Hospital, I;stanbul (Avr), Turkey.
BACKGROUND:Robotic-assisted thoracic surgery offers significant advantages in precision and patient outcomes. Among these advancements, robotic bronchial sleeve resection is an emerging technique with limited patient data and clinical experience. This study evaluates the outcomes of 19 patients who underwent robotic bronchial sleeve resections at two centers located in different countries and continents, using the same surgical principles and techniques.
METHODS: The study included 19 patients (13 males, 6 females; median age 59 ± 17.2 years, range 18-67) treated at Istanbul Florence Nightingale Hospital (FNH) Thoracic Surgery Program (n=12) and West Virginia University (WVU) Department of Cardiovascular and Thoracic Surgery (n=7). Tumor types included 7 carcinoid tumors, 5 adenocarcinomas, 6 squamous cell carcinomas, and 1 small cell carcinoma. The procedure was performed on various lobes, with a predominance of right upper lobe resections (n=10). Data collected included tumor size, neoadjuvant treatment, lymph node dissection count, operative time, hospital stay duration, and postoperative complications.
RESULTS:Two patients underwent right upper sleeve lobectomy after neoadjuvant chemo-immunotherapy. The median number of lymph nodes dissected from N1 and N2 stations was 18 ± 9.2 (range 6-43, mean 19.8 ± 9.2), with nodal positivity in 8 patients (6 N1 positive, 2 N2 positive). The average tumor size was 2.3 ± 1.4 cm (mean 2.38 ± 1.4 cm). The median operative time was 180 minutes (mean 154.2 ± 71.8 minutes), and the median duration of hospitalization was 7.5 ± 4.2 days (mean 7 ± 4.3 days). Both operative time and hospital stay duration decreased as surgical experience increased.
CONCLUSIONS:Robotic bronchial sleeve lobectomy demonstrated favorable outcomes, with acceptable complication and readmission rates. The findings suggest a learning curve effect, with improvements in operative efficiency and patient recovery as experience grew. Robotic bronchial sleeve resection is a safe and effective option for managing complex thoracic cases, offering precise outcomes with manageable complications.This technique shows promise as a viable alternative for treating challenging lung tumors, though further research is needed to confirm long-term outcomes and optimize procedural techniques.
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