Switching from Thoracoscopic to Robotic Platform for Lobectomy: Report of Learning Curve and Outcome.

Autor:	Lee EC; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Lazzaro RS; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Glassman LR; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Singh VA; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Jurado JE; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Hyman KM; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Patton BD; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Zeltsman D; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Scheinerman JS; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Hartman AR; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA., Lee PC; 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA.
Jazyk:	angličtina
Zdroj:	Innovations (Philadelphia, Pa.) [Innovations (Phila)] 2020 May/Jun; Vol. 15 (3), pp. 235-242. Date of Electronic Publication: 2020 Mar 31.
DOI:	10.1177/1556984520911670
Abstrakt:	Objective: The optimal minimally invasive surgical management for patients with non-small-cell lung cancer (NSCLC) is unclear. For experienced video-assisted thoracoscopic surgery (VATS) surgeons, the increased costs and learning curve are strong barriers for adoption of robotics. We examined the learning curve and outcome of an experienced VATS lobectomy surgeon switching to a robotic platform. Methods: We conducted a retrospective review to identify patients who underwent a robotic or VATS lobectomy for NSCLC from 2016 to 2018. Analysis of patient demographics, perioperative data, pathological upstaging rates, and robotic approach (RA) learning curve was performed. Results: This study evaluated 167 lobectomies in total, 118 by RA and 49 by VATS. Patient and tumor characteristics were similar. RA had significantly more lymph node harvested (14 versus 10; P = 0.004), more nodal stations sampled (5 versus 4; P < 0.001), and more N1 nodes (8 versus 6; P = 0.010) and N2 nodes (6 versus 4; P = 0.017) resected. With RA, 22 patients were upstaged (18.6%) compared to 5 patients (10.2%) with VATS ( P = 0.26). No differences were found in perioperative outcome. Operative time decreased significantly with a learning curve of 20 cases, along with a steady increase in lymph node yield. Conclusions: RA can be adopted safely by experienced VATS surgeons. Learning curve is 20 cases, with RA resulting in superior lymph node clearance compared to VATS. The potential improvement in upstaging and oncologic resection for NSCLC may justify the associated investments of robotics even for experienced VATS surgeons.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu