Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

Abstract

More and more data are available on the benefits of minimally invasive thoracic surgery compared to open thoracic surgery in the curative treatment of early-stage non-small cell lung cancer. However, results are conflicting, especially when video-assisted thoracoscopic surgery (VATS) is compared to robotic-assisted thoracoscopic surgery (RATS) for lobectomy. Our goal is to report the main results of recent systematic reviews and meta-analyses comparing RATS, VATS, and open surgery for lobectomy. Using PubMed database, we selected systematic reviews and meta-analyses, which compared the short-term outcomes of patients treated by RATS, VATS, or open surgery for lobectomy. In all but one of the systematic reviews, robotic lobectomy allowed similar short-term outcomes as VATS lobectomy and better short-term outcomes than open surgery. One meta-analysis by O'Sullivan et al. found that robotic lobectomy was associated with fewer adverse events (P < 0.00001) and lower 30-day mortality (P = 0.001), compared to VATS lobectomy. Robotic lobectomy could be a valid alternative to VATS and open lobectomy. Shortterm outcomes do not appear to be different between VATS and RATS cohorts, except in one recent meta-analysis, which reported the superiority of RATS compared to VATS. Without cost analysis and randomized controlled trials with long-term outcomes, no strong conclusions can be drawn.

Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis

“…The ideal approach should minimize patient morbidity in order to enhance recovery, ensure a return to daily activities in a reasonable period of time and maximize oncologic outcomes. Minimally invasive approaches have long been established as suitable for resection of early-stage lung cancer [ 21 , 22 ], but no prospective randomized trials evaluating their relative efficacy and oncologic equivalence in comparison to open surgery are yet available. Indeed, comparative studies between VATS, RATS and open surgery are lacking, with most of them investigating short-term outcomes and providing poor evidence of comparable long-term oncological results.…”

Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19

“…At the posterior end of a thoracotomy wound (especially where a portion of rib has been excised), other adjuncts such as oxidised cellulose or active flowable haemostat (gelatin & thrombin) can be used [ 54 , 62 ]. The use of VATS and RATS in Thoracic Surgery has increased [ 63 , 64 ]. Use of electrocautery for adequate haemostasis is important particularly in robotics, where the ports are tight with the movement of the arms.…”

Current medical and surgical management of lung cancer

“…More recent randomised trials however have reported no difference in postoperative measures including major complications and 30 and 90 day mortality between patients having undergone lobectomy versus segmentectomy [23,24]. Technological developments resulted in introduction of robot-assisted thoracoscopic surgery (RATS), which provides an option for a minimally invasive thoracic surgical approach with evidence of improved short-term outcomes compared with VATS and no signifi cant difference in fi ve-year overall survival [25]. Robotic surgery allows for greater precision and manoeuvrability as evidenced by the results of a propensity matched study comparing robotic to open lobectomy, which showed an increase in median node evaluation with robotic resection [26].…”