Robotic is better than VATS? Ten good reasons to prefer robotic versus manual VATS surgery in lung cancer patients

Solinas, Michela; Novellis, Pierluigi; Veronesi, Giulia

doi:10.21037/vats.2017.09.01

Cited by 5 publications

(6 citation statements)

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“…5 In addition, despite a similar level of decline in the rate of conversion, VATS was consistently associated with a higher conversion rate when compared to RATS (12.3% vs 7.9%, P < 0.01) and was an independent predictor of conversion to thoracotomy in the present study. The advantages of the robot in reducing conversion may be related to the superior visibility, ergonomics, and wristed movements offered by the platform, 12,16 as well as reducing the learning curve for the performance of minimally invasive procedures. 17 We also noted, as expected, that a sublobar resection was associated with a lower conversion rate.…”

Section: Discussionmentioning

confidence: 99%

Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes

Muslim

Stroever²,

Poulikidis

et al. 2022

Innovations�(Phila)

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Objective: We aimed to identify predictors of conversion to thoracotomy and test the hypothesis that conversion is associated with inferior perioperative outcomes in non-small cell lung cancer (NSCLC). Methods: We queried the National Cancer Database for patients with stage I to III NSCLC undergoing minimally invasive surgery (MIS) during 2010 to 2016. We compared clinicopathologic factors between patients undergoing MIS with and without conversion. We fitted multivariable regression models to identify independent predictors of conversion and compare perioperative outcomes between the 2 groups. Results: A rising trend in the use of MIS was accompanied by a declining trend in the rate of conversion to thoracotomy. A total of 11.3% of the 83,219 cases were converted. Conversion was associated with a higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, tumor size ≥5 cm, and a higher T stage ( P < 0.05). Successful MIS without conversion was predicted by advanced age, sublobar resection, robotic approach, and treatment at an academic high-volume facility ( P < 0.05). Conversion was linked to longer hospital stays, higher 30-day and 90-day mortality, and unplanned readmission ( P < 0.05), irrespective of the type of MIS approach. Conclusions: Conversion rates for video-assisted and robot-assisted thoracoscopic surgery have seen a decline in recent years. Irrespective of the type of MIS approach, conversion was associated with inferior perioperative outcomes. The robotic approach and treatment at an academic high-volume facility were associated with a lower likelihood of conversion. Early recognition of the individual risk factors for conversion may help to counsel patients about the likelihood of, and detriments associated with, conversion and ultimately reduce conversion rates.

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Section: Discussionmentioning

confidence: 99%

Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes

Muslim

Stroever²,

Poulikidis

et al. 2022

Innovations�(Phila)

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“…Video-assisted thoracoscopic surgery (VATS) and, more recently, robotic-assisted thoracoscopic surgery (RATS) have been associated with reduced hospital length of stay, improved pain and quicker recovery compared with open approaches 5. Proponents of RATS have argued that it provides multiple clinical advantages over VATS including: improved visualisation, ergonomics, manoeuvrability, motion-scaling and tremor filtering, as well as a shorter learning curve 5…”

Section: Discussionmentioning

confidence: 99%

Transcervical and robotic-assisted thoracoscopic resection of a substernal goiter

2022

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Several genetic and environmental factors contribute to the development of multinodular goitre. A transcervical surgical resection is recommended for larger goitres, though a minority of cases may require sternotomy or thoracotomy. We present a case of a posterior substernal goitre that was resected with combined transcervical and robotically assisted thoracic approaches. A woman in her 30s with an enlarging thyroid goitre elected to proceed with surgical resection. CT imaging demonstrated significant extension of the goitre into the posterior mediastinum and a staged approach was decided on. Both the initial transcervical thyroidectomy and the subsequent robotically assisted resection of the mediastinal portion were successful, without major complications. While most substernal goitres can be resected transcervically, certain rare anatomic features, such as extension into the posterior mediastinum, warrant consideration of a thoracic approach. Specifically, a robotic-assisted resection poses several advantages over traditional, more invasive approaches.

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Section: Discussionmentioning

confidence: 99%

“…More likely, the improved depth perception, visualization, tremor filtering, ergonomics, and rotational movement of tools provided by the robotic approach as described by Solinas et al allows for improved ability to adapt to unplanned situations and deal with difficult-to-manage phases of the operation, such as lymph node dissection. 15 While conversion rates are improving, they have not yet stabilized, indicating room for even further improvement. Identification of risk factors may further contribute to declining conversion rates and ultimately improve patient care.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Lobectomy Modality and Other Predictors of Conversion to Thoracotomy

Hendriksen

Hollenbeak

Taylor

et al. 2019

Innovations�(Phila)

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Objective Minimally invasive approaches to lobectomy are increasing. Rates of conversion to thoracotomy are well reported but risk factors are poorly understood. This study aimed to determine the impact of surgical modality (video-assisted thoracoscopic surgery [VATS] and robotic) on conversion as well as to identify other risk factors for conversion. Methods The National Cancer Database (NCDB) was used to identify patients who underwent minimally invasive lobectomy between 2010 and 2015. Patient characteristics were compared between VATS and robotic approaches using chi-squared tests and t-tests. Logistic regression models were used to control for covariates and identify factors associated with all minimally invasive conversion, VATS conversion, and robotic conversion. Propensity score matching was used to compare conversion rates of VATS and robotic lobectomy. Results The study included 51,723 patients with lung cancer who underwent minimally invasive lobectomy (VATS or robotic). Conversion was identified in 7,109 (7.3%) operations. The odds of VATS conversions were nearly twice that of robotic conversions (OR 1.94 P < 0.0001). After controlling for VATS and robotic patient imbalances with propensity score matching, there was a 5% difference in conversion rates (14% vs. 9%, P < 0.0001). Other predictors of minimally invasive conversion included community hospitals, tumor size 4.5 cm or greater, and an increasing Charlson comorbidity index ( P < 0.03 for all). Conclusions VATS is associated with nearly twice the odds of conversion as robotic lobectomy. Identifying specific risk factors for both VATS and robotic conversions may aid in appropriate modality selection and reduction of conversions.

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Robotic is better than VATS? Ten good reasons to prefer robotic versus manual VATS surgery in lung cancer patients

Cited by 5 publications

References 0 publications

Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes

Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes

Transcervical and robotic-assisted thoracoscopic resection of a substernal goiter

Minimally Invasive Lobectomy Modality and Other Predictors of Conversion to Thoracotomy

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