Experience with robotic lobectomy for lung cancer

OBJECTIVE: In this study, we analyze our experience so far with robotic pulmonary lobectomy, compare it with published data, and suggest a learning curve for the operation. METHODS: Ninety-one patients with suspected or proven clinical stage I-III lung cancer underwent robotic lobectomy. Selection criteria included lesion <5 cm and normal respiratory function. One surgeon performed the operations using the da Vinci system with three ports and a 3-cm utility thoracotomy. RESULTS: Median duration of operation was 239 (range 85-411) minutes, 260 minutes in the first 18 patients and 221 minutes in the remaining 73 cases (P=0.01). Median hospitalization declined from 6 days in the first 18 cases to 5 days in the remaining cases (P=0.002). Conversion rate and number of complications reduced nonsignificantly from the initial to later series. Major complications occurred in 11% of the first 18 cases and 4% of the later cases. The number of lymph nodes removed did not change over the two series. There was no 30-day postoperative mortality. After a median follow-up of 24 months, 80 of 91 patients were alive with no sign of disease. CONCLUSIONS: Our data suggest that about 20 operations are required to achieve surgical competence. Robotic lobectomy appears safe, oncologically radical, and associated with shorter postoperative hospitalization than open surgery.