Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms
Robert J. Cerfolio, MD, FACS, FCCP*, Ayesha S. Bryant, MD, MSPH, Loki Skylizard, MD, Douglas James Minnich, MD, FACS
Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
Received for publication March 21, 2011; revisions received June 1, 2011; accepted for publication July 14, 2011.
* Address for reprints: Robert J. Cerfolio, MD, FACS, FCCP, Professor of Surgery, Chief of Thoracic Surgery, JH Estes Family Endowed Chair for Lung Cancer Research, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294. (Email: rcerfolio@uab.edu).
Background: Many general thoracic surgeons are learning robotic pulmonaryresection.
Methods: We retrospectively compared results of completely portal robotlobectomy with 4 arms (CPRL-4) against propensity-matched controlsand results after technical changes to CPRL-4.
Results: In 14 months, 168 patients underwent robotic pulmonary resection:7 had metastatic pleural disease, 13 had conversion to openprocedures, and 148 had completion robotically (106 lobectomies,26 wedge resections, 16 segmentectomies). All patients underwentR0 resection and removal of all visible lymph nodes (medianof 5 N2, 3 N1 nodal stations, 17 lymph nodes). The 106 patientswho underwent CPRL-4 were compared with 318 propensity-matchedpatients who underwent lobectomy by rib- and nerve-sparing thoracotomy.The robotic group had reduced morbidity (27% vs 38%; P = .05),lower mortality (0% vs 3.1%; P = .11), improved mentalquality of life (53 vs 40; P < .001), and shorterhospital stay (2.0 vs 4.0 days; P = .02). Resultsof CPRL-4 after technical modifications led to reductions inmedian operative time (3.7 vs 1.9 hours; P < .001)and conversion (12/62 vs 1/106; P < .001). Technicalimprovements were addition of fourth robotic arm for retraction,vessel loop to guide the stapler, tumor removal above the diaphragm,and carbon dioxide insufflation.
Conclusions: The newly refined CPRL-4 is safe and yields an R0 resectionwith complete lymph node removal. It has lower morbidity, mortality,shorter hospital stay, and better quality of life than rib-and nerve-sparing thoracotomy. Technical advances are possibleto shorten and improve the operation.