Effect of small body habitus on peri-operative outcomes after robotic-assisted pulmonary lobectomy: retrospective analysis of 208 consecutive cases.
BACKGROUND
Patients with smaller body surface area (BSA) have smaller pleural cavities, which limit visualization and instrument mobility during video-assisted thoracoscopic surgery (VATS). We investigated the effects of BSA on outcomes with robotic-assisted VATS lobectomy.


METHODS
We analyzed 208 consecutive patients who underwent robotic-assisted lobectomy over 34 months. Patients were separated into group A (BSA ≤1.65 m(2)) and group B (BSA >1.65 m(2)). Operative times, estimated blood loss (EBL), conversions to thoracotomy, complications, hospital length of stay (LOS), and in-hospital mortality were compared.


RESULTS
Group A had 40 patients (BSA 1.25-1.65 m(2)), and group B had 168 patients (BSA 1.66-2.86 m(2)). Median skin-to-skin operative times [± standard error of the mean (SEM)] were 169±16 min for group A and 176±6 min for group B (P=0.34). Group A had median EBL of 150±96 mL compared to 200±24 mL for group B (P=0.37). Overall conversion rate to thoracotomy was 8/40 (20.0%) in group A versus 12/168 (7.1%) in group B (P=0.03); while emergent conversion for bleeding was 2/40 (5.0%) in group A versus 5/168 (3.0%) in group B (P=0.62). Postoperative complications occurred in 12/40 (30.0%) in group A, compared to 66/168 (39.3%) in group B (P=0.28). Patients from both groups had median hospital LOS of 5 days (P=0.68) and had similar in-hospital mortality.


CONCLUSIONS
Patients with BSA ≤1.65 m(2) have similar perioperative outcomes and complication risks as patients with larger BSA. Patients with BSA ≤1.65 m(2) have a higher overall conversion rate to thoracotomy, but similar conversion rate for bleeding as patients with larger BSA. Robotic-assisted pulmonary lobectomy is feasible and safe in patients with small body habitus.
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Frank O
FO
Velez-Cubian
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Wei-Wei
WW
Zhang
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Kathryn L
KL
Rodriguez
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Matthew R
MR
Thau
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Emily P
EP
Ng
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Carla C
CC
Moodie
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Joseph R
JR
Garrett
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Jacques-Pierre
JP
Fontaine
1 Department of Surgery, University of South Florida, Tampa, FL, USA ; 2 Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; 3 Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA ; 4 Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
Eric M
EM
Toloza
Lung cancer; body surface area (BSA); lobectomy; robotic