Four-arm robotic lung resection versus muscle-sparing mini-thoracotomy: retrospective experience

Robotic lobectomy in children with severe bronchiectasis: A worthwhile new technology

BACKGROUND/PURPOSE

Lobectomy is required in children affected by non-responsive, symptomatic, localized bronchiectasis, but inflammation makes thoracoscopy challenging. We present the first published series of robotic-assisted pulmonary lobectomy in children with bronchiectasis.

METHODS

Retrospective analysis of all consecutive patients who underwent pulmonary lobectomy for severe localized bronchiectasis (2014-2019) via thoracoscopic versus robotic lobectomy. Four 5 mm ports were used for thoracoscopy; a four-arm approach was used for robotic surgery (Da Vinci Surgical Xi System, Intuitive Surgical, California).

RESULTS

Eighteen children were operated (robotic resection, n = 7; thoracoscopy, n = 11) with infected congenital pulmonary malformation, primary ciliary dyskinesia, and post-viral infection. There were no conversions to open surgery with robotic surgery, but five with thoracoscopy. Total operative time was significantly longer with robotic versus thoracoscopic surgery (mean 247 ± 50 versus 152 ± 57 min, p = 0.008). There were no significant differences in perioperative complications, length of thoracic drainage, or total length of stay (mean 7 ± 2 versus 8 ± 3 days, respectively). No blood transfusions were required. Two thoracoscopic patients had a type-3 postoperative complication.

CONCLUSIONS

Pediatric robotic lung lobectomy is feasible and safe, with excellent visualization and bi-manual hand-wrist dissection - useful properties in difficult cases of infectious pathologies. However, instrumentation dimensions limit use in smaller thoraxes.

Robotic surgery for thoracic surgery

Indications for the use of RATS vary between the facilities but correspond as far as possible to other minimally invasive surgical findings. In general, RATS is currently a therapeutic option for the management of early-stage NSCLC without mediastinal lymph node involvement in oncological surgery, although depending on the planned intervention and the surgical facility, hilar lymph node involvement may be accepted