A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)

Abstract

Objective: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. Methods: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. Results: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. Conclusions: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding. (ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/])

CONSORT Harms 2022 statement, explanation, and elaboration: updated guideline for the reporting of harms in randomised trials

“…We also assessed the need for opioid use at the 30-day outpatient visit. Any hospitalization within the 90-day postoperative period was considered as readmission”77. [In this example, “complications” is used as a reference to harm outcomes; preferable terms are “harms” or “adverse events.”]…”

Robot-assisted surgery in thoracic and visceral indications: an updated systematic review

“…Safety One RCT [ 29 ] reported readmissions, showing statistically significant results favouring the intervention group (intervention group [IG]: 1 [3%] vs control group [CG]: 8 [21%]; p = 0.029).…”

Mortality index is more accurate than volume in predicting outcome and failure to rescue in Medicare beneficiaries undergoing robotic right upper lobectomy

“…The literature is replete with comparisons of robotic versus open surgical approaches to lobectomies. 10 , 31 , 32 , 33 Indeed, there is a tacit acceptance of the advantages of the minimally, invasive robotic approach and it has become a legitimate alternative to video assisted thoracic surgery. 10 , 33 Advantages include decreased operative blood loss, faster postoperative recovery, fewer complications, and a less steep learning curve.…”

“… 10 , 31 , 32 , 33 Indeed, there is a tacit acceptance of the advantages of the minimally, invasive robotic approach and it has become a legitimate alternative to video assisted thoracic surgery. 10 , 33 Advantages include decreased operative blood loss, faster postoperative recovery, fewer complications, and a less steep learning curve. 34 , 35 , 36 The burgeoning growth of viable robotic programs, nevertheless, is predicated on an existence of a platform of services that can permit, reliable, high-quality outcomes.…”