title: Robotic video-assisted thoracoscopic lung resection for lung tumors: a community tertiary care center experience over four years.
abstract: BACKGROUND
  After its initial description in 1990, video-assisted thoracoscopic surgery (VATS) has emerged as the minimally invasive approach for lung resection in early lung cancer.
  
  
  METHODS
  A retrospective review of prospectively collected data on patients who underwent robotic pulmonary resection for cancer by a single surgeon, between years 2009 and 2013, was performed. Age, gender, type and duration of surgery, length of stay, estimated blood loss, early and late complications, follow-up time, and local recurrence were reviewed and analyzed descriptively.
  
  
  RESULTS
  Three hundred and thirty-one patients underwent the procedure for pulmonary neoplasm. Two hundred and fifty-nine (79%) patients underwent anatomic lobectomies, 56 (17%) patients had wedge resection, while five (1.5%) patients underwent pneumonectomy. In 11 patients, no pulmonary resection was performed for different reasons. Most common neoplasm was adenocarcinoma (185, 56%). All procedures involved a systematic mediastinal and hilar lymph node exploration and removal of suspicious nodes. Twenty-six (6.9%) procedures were converted to open thoracotomy. Mean duration of surgery was 185.63 min. Mean length of hospital stay was 5.52 days. Mean estimated blood loss (EBL) was 47.85 ml. Mean follow-up was 249.41 days (20-1550 days), and five (1.5%) patients developed local recurrence. Early complications were seen in 29 patients (8.8%), most commonly cardiac arrhythmias (20, 6%).
  
  
  CONCLUSIONS
  Robotic video-assisted thoracoscopic surgery is feasible in lung lesions, with all the advantages of VATS in terms of decreased length of stay and decreased blood loss with local recurrence rate and complication rate comparable to open procedures. There is a clear need for more studies comparing the apparent advantages of robotic-assisted surgery with increased cost of technology.
authors.affiliation: Division of Thoracic Oncology, Mount Sinai Medical Center, Miami Beach, FL, USA. pradkani@gmail.com.
authors.forename: Pejman
authors.initials: P
authors.lastname: Radkani
authors.affiliation: Division of Thoracic Oncology, Mount Sinai Medical Center, Miami Beach, FL, USA.
authors.forename: Devendra
authors.initials: D
authors.lastname: Joshi
authors.affiliation: Division of Thoracic Oncology, Mount Sinai Medical Center, Miami Beach, FL, USA.
authors.forename: Tushar
authors.initials: T
authors.lastname: Barot
authors.affiliation: Division of Thoracic Oncology, Mount Sinai Medical Center, Miami Beach, FL, USA.
authors.forename: Roy F
authors.initials: RF
authors.lastname: Williams
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D002276:Carcinoid Tumor / Q000601:surgery*; D018287:Carcinoma, Large Cell / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery*; D008223:Lymphoma / Q000601:surgery; D008297:Male; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D062606:Tertiary Care Centers; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy
keywords: Lung cancer; Minimally invasive; Robotic; Robotic VATS