Uniportal Video-assisted Lung Resection Versus Robotic-assisted Lung Resection, is There a Difference?

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2024 Dec 16

PMID 39678844

Authors

James Shahoud

Benny Weksler

Brent Williams

Conor Maxwell

Hiran C Fernando

Affiliations

Soon will be listed here.

Abstract

Background: There has been increasing adoption of robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (uVATS) for lung resection. We undertook a single-institution retrospective study, comparing these approaches.

Methods: An analysis was performed of patients who underwent lung resection by either uVATS or RATS. Operations were performed between July 1, 2020 and July 1, 2021. Two surgeons [one experienced in RATS, the other experienced in multi-portal VATS (mVATS), with the recent adoption of uVATS] performed all operations. Patients with known or suspected lung cancer or metastases were included. In addition to baseline characteristics, adverse events [as defined in the Society of Thoracic Surgeons (STS) General Thoracic Database], subjective pain scores (scale 1-10), and morphine equivalent dose (MED) requirement were compared for patients who remained in the hospital on post-operative days (POD) 1 to 4. For patients with lung cancer, recurrence rates, overall survival, and recurrence-free survival were evaluated.

Results: There were 128 (50 uVATS and 78 RATS) patients. Although uVATS patients were older (70 versus 65 years; P=0.01), there was no difference in baseline forced expiratory volume in the first second (FEV)%, diffusing capacity for carbon monoxide (DLCO)%, body mass index, and American Society of Anesthesiologists (ASA) scores. Mean procedure times and adverse event rates were similar. Four major complications occurred (all unanticipated return to the operating room). The 30- and 90-day mortality was zero. RATS was associated with shorter hospital stay (2.6 versus 4 days; P=0.02) and improved lymph node (15.3 versus 9.9; P=0.003) dissection. MED requirement was significantly reduced on POD 2-4 after uVATS, on both univariate and multivariate analysis. Ninety-four patients (uVATS; n=38, RATS; n=56) had primary lung cancer. Median follow-up was 15.6 months for these patients. Recurrence occurred in 4/34 (11.8%) uVATS and 7/56 (12.5%) RATS patients (P=0.77). There were no differences in overall survival or time to recurrence.

Conclusions: UVATS and RATS lung resections were associated with similar post-operative adverse event rates. Lymph node dissection and length of stay were improved with RATS. Oncological outcomes were similar. UVATS was associated with lower morphine requirement. Prospective studies will help further clarify the differences between these approaches.

References

Ng C, MacDonald J, Gilbert S, Khan A, Kim Y, Louie B . Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis. Innovations (Phila). 2019; 14(2):90-116. DOI: 10.1177/1556984519837027. View

Yang S, Guo W, Chen X, Wu H, Li H . Early outcomes of robotic versus uniportal video-assisted thoracic surgery for lung cancer: a propensity score-matched study. Eur J Cardiothorac Surg. 2017; 53(2):348-352. DOI: 10.1093/ejcts/ezx310. View

Detillon D, Veen E . Postoperative Outcome After Pulmonary Surgery for Non-Small Cell Lung Cancer in Elderly Patients. Ann Thorac Surg. 2017; 105(1):287-293. DOI: 10.1016/j.athoracsur.2017.07.032. View

Mier J, Chavarin A, Izquierdo-Vidal C, Fibla J, Molins L . A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study. Surg Endosc. 2013; 27(7):2557-60. DOI: 10.1007/s00464-012-2782-6. View

Scott W, Allen M, Darling G, Meyers B, Decker P, Putnam J . Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010; 139(4):976-81. DOI: 10.1016/j.jtcvs.2009.11.059. View

Velez-Cubian F, Rodriguez K, Thau M, Moodie C, Garrett J, Fontaine J . Efficacy of lymph node dissection during robotic-assisted lobectomy for non-small cell lung cancer: retrospective review of 159 consecutive cases. J Thorac Dis. 2016; 8(9):2454-2463. PMC: 5059267. DOI: 10.21037/jtd.2016.08.25. View

Mohiuddin K, Swanson S . Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013; 108(5):315-9. DOI: 10.1002/jso.23398. View

Montagne F, Chaari Z, Bottet B, Sarsam M, Mbadinga F, Selim J . Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel). 2022; 14(11). PMC: 9179652. DOI: 10.3390/cancers14112611. View

Higuchi M, Yaginuma H, Yonechi A, Kanno R, Ohishi A, Suzuki H . Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg. 2014; 9:88. PMC: 4058716. DOI: 10.1186/1749-8090-9-88. View

10.

Lim E, Harris R, Batchelor T, Casali G, Krishnadas R, Begum S . Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer. JTCVS Open. 2024; 19:296-308. PMC: 11247214. DOI: 10.1016/j.xjon.2024.02.025. View

11.

Reinersman J, Passera E, Rocco G . Overview of uniportal video-assisted thoracic surgery (VATS): past and present. Ann Cardiothorac Surg. 2016; 5(2):112-7. PMC: 4827399. DOI: 10.21037/acs.2016.03.08. View

12.

Park B, Melfi F, Mussi A, Maisonneuve P, Spaggiari L, Da Silva R . Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg. 2011; 143(2):383-9. DOI: 10.1016/j.jtcvs.2011.10.055. View

13.

Zhang J, Feng Q, Huang Y, Ouyang L, Luo F . Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol. 2022; 12:853530. PMC: 9039645. DOI: 10.3389/fonc.2022.853530. View

14.

Tamura M, Shimizu Y, Hashizume Y . Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg. 2013; 8:153. PMC: 3691684. DOI: 10.1186/1749-8090-8-153. View

15.

Kumar A, Asaf B . Robotic thoracic surgery: The state of the art. J Minim Access Surg. 2015; 11(1):60-7. PMC: 4290121. DOI: 10.4103/0972-9941.147693. View

16.

Kneuertz P, DSouza D, Richardson M, Abdel-Rasoul M, Moffatt-Bruce S, Merritt R . Long-Term Oncologic Outcomes After Robotic Lobectomy for Early-stage Non-Small-cell Lung Cancer Versus Video-assisted Thoracoscopic and Open Thoracotomy Approach. Clin Lung Cancer. 2019; 21(3):214-224.e2. DOI: 10.1016/j.cllc.2019.10.004. View

17.

Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L . Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg. 2012; 95(2):426-32. DOI: 10.1016/j.athoracsur.2012.10.070. View

18.

Merritt R, Abdel-Rasoul M, DSouza D, Kneuertz P . Comparison of the long-term oncologic outcomes of robotic-assisted and video-assisted thoracoscopic lobectomy for resectable non-small cell lung carcinoma. J Robot Surg. 2022; 16(6):1281-1288. DOI: 10.1007/s11701-022-01368-y. View