title: Four-arm robotic lobectomy for the treatment of early-stage lung cancer.
abstract: OBJECTIVE
  We investigated the feasibility and safety of four-arm robotic lung lobectomy in patients with lung cancer and described the robotic lobectomy technique with mediastinal lymph node dissection.
  
  
  METHODS
  Over 21 months, 54 patients underwent robotic lobectomy for early-stage lung cancer at our institute. We used a da Vinci Robotic System (Intuitive Surgical, Inc, Mountain View, Calif) with three ports plus one utility incision to isolate hilum elements and perform vascular and bronchial resection using standard endoscopic staplers. Standard mediastinal lymph node dissection was performed subsequently. Surgical outcomes were compared with those in 54 patients who underwent open surgery over the same period and were matched to the robotic group using propensity scores for a series of preoperative variables.
  
  
  RESULTS
  Conversion to open surgery was necessary in 7 (13%) cases. Postoperative complications (11/54, 20%, in each group) and median number of lymph nodes removed (17.5 robotic vs 17 open) were similar in the 2 groups. Median robotic operating time decreased by 43 minutes (P = .02) from first tertile (18 patients) to the second-plus-third tertile (36 patients). Median postoperative hospitalization was significantly shorter after robotic (excluding first tertile) than after open operations (4.5 days vs 6 days; P = .002).
  
  
  CONCLUSIONS
  Robotic lobectomy with lymph node dissection is practicable, safe, and associated with shorter postoperative hospitalization than open surgery. From the number of lymph nodes removed it also appears oncologically acceptable for early lung cancer. Benefits in terms of postoperative pain, respiratory function, and quality of life still require evaluation. We expect that technologic developments will further simplify the robotic procedure.
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy. giulia.veronesi@ieo.it
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.forename: Ralph Alexander
authors.initials: RA
authors.lastname: Schmid
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Fernando
authors.initials: F
authors.lastname: Vannucci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome