title: Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting.
abstract: OBJECTIVE
  Minimally invasive lung lobectomy was introduced in the late 1990s. Since that time, various different approaches have been described. At our institution, two different minimally invasive approaches, a robotic and a conventional thoracoscopic one, were performed for pulmonary lobectomies. This study compares perioperative outcome of the two different techniques in a learning curve setting.
  
  
  METHODS
  Between 2001 and 2008, 26 patients underwent lung lobectomy with a robotic-assisted thoracoscopic surgery (RATS) technique. In 2009, the minimally invasive approach was changed to a conventional video-assisted thoracoscopic surgery (VATS) technique. Perioperative results of the first 26 VATS patients were compared to the results of the robotic group.
  
  
  RESULTS
  There were significantly more patients with clinical stage >IB in the VATS group than in the robotic-assisted group (23.1 vs. 0 %). Otherwise, demographic data were equal between the groups. Operative time was significantly longer in the robotic group (215 vs. 183 min, p = 0.0362). Median difference between preoperative hemoglobin levels and levels on postoperative day 1 was higher in the RATS group, suggesting a higher blood loss. No difference was found in conversion rate, acute phase protein levels (C-reactive protein), chest drain duration, postoperative morbidity and mortality, and length of hospital stay. Procedural costs were higher for the robotic approach (difference, 770.55 <euro>, i.e., 44.4 %).
  
  
  CONCLUSIONS
  Shorter operative times, a lower drop of postoperative hemoglobin levels indicating less blood loss, and lower procedural costs suggest a benefit of the VATS approach over the robotic approach for minimally invasive lung lobectomy.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. florian.augustin@i-med.ac.at
authors.forename: Florian
authors.initials: F
authors.lastname: Augustin
authors.forename: Johannes
authors.initials: J
authors.lastname: Bodner
authors.forename: Herbert
authors.initials: H
authors.lastname: Maier
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwinghammer
authors.forename: Burkhard
authors.initials: B
authors.lastname: Pichler
authors.forename: Paolo
authors.initials: P
authors.lastname: Lucciarini
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D059032:Learning Curve; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D019990:Perioperative Care; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000191:economics / Q000379:methods*; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome