title: Robotic Versus Thoracoscopic Resection for Lung Cancer: Early Results of a New Robotic Program.
abstract: BACKGROUND
  Robot-assisted surgical techniques have been introduced in recent years as an alternative minimally invasive approach for lung surgery. While the advantage of video-assisted thoracoscopic surgery (VATS) over thoracotomy for anatomical lung resection has been extensively reported, the results of robotic video-assisted thoracoscopic surgery (RVATS) compared to VATS are still under investigation.
  
  
  METHODS
  We performed a retrospective review of lung cancer patients, undergoing minimally invasive segmentectomy or lobectomy between December 2007 and May 2014. A robotic program was introduced in 2011. Relevant early surgical outcomes were compared between VATS and RVATS, including mortality, morbidity, conversion to thoracotomy, length of stay (LOS), and reoperation.
  
  
  RESULTS
  Eighty (60.2%) patients underwent VATS resection, while 53 (39.8%) had a RVATS procedure. The two groups presented no meaningful differences at baseline, in terms of age, race, body mass index, and preoperative comorbidities. Adenocarcinoma was the most common histology in both groups. Patients in the RVATS group had significantly more segmentectomies (11.3% versus 1.2%, P = .016). There were no postoperative deaths. RVATS appeared to be associated with fewer conversions to open (13.2% versus 26.2%, P = .025) and more lymph nodes retrieved (9 versus 7, P = .049). We found no significant differences in terms of other individual complications, including tracheostomy, reintubation, pneumonia, pulmonary embolism, and cerebrovascular events.
  
  
  CONCLUSIONS
  According to our results, the introduction of a robotic program did not negatively affect the early surgical outcomes of a well-established oncologic minimally invasive thoracic program. Potential advantages of RVATS still need to be explored in terms of long-term outcomes.
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Janelle S Y
authors.initials: JS
authors.lastname: Ho
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Battafarano
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
authors.affiliation: 2 Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center , New York, New York.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D061887:Conversion to Open Surgery; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy