Background: Thoracic lung surgery is an intricate process that often leads to long hospital stays or surgical complications. Traditional open-lung surgery has been challenged by video-assisted thorascopic surgery (VATS), a minimally invasive technique introduced in the 1990s that utilizes a remote video camera introduced through into the body through a scope. This is now being challenged further by the development of robotic-assisted surgery. Human-controlled mechanical arms enter the body cavity through small ports, allowing entire operations to be done without any major incisions. This emerging, minimally invasive technique can allow for faster patient recovery and shorter hospital stays.
Objectives: Our primary objective was to assess the outcomes of three types of thoracic lung surgery techniques: open lung surgery, video-assisted thorascopic surgery (VATS), and robotic-assisted surgery (RA). Following this, we wanted to compare RA surgery to open surgery and VATS. We also wanted to analyze the trends of RA surgery over the course of three years.
Methods: We looked over 525 consecutive patients partaking in lobectomies and segmentectomies between June 2008 and July 2013. We thoroughly researched and analyzed the following outcomes: length of stay in days after surgery, mortality rate within 30 days of surgery, readmission rate within 30 days of discharge, and conversion rate to open surgery. Within robotic-assisted surgery, we also analyzed the percentage of patients going home within one and two days of the operation and readmission rates over time between June 2011 and July 2013.
Results: Open surgery was performed on 302 patients, VATS on 125 patients, and RA surgery on 98 patients, with robotic surgeries only occurring between 2011 and 2013. The median length of stay was 6 days for open, 3.5 for VATS, and 2 for RA surgery (p
Conclusions: Patients who underwent RA surgery stayed on average 1.5 less days than VATS, and 4 less days than open. Readmission rates between the three techniques were not significantly different, but this value was no higher for RA surgery than any other. The overall cost to the hospital would in turn be less for RA surgery patients, who are more likely to be discharged quickly without any change in readmission rate. Trends toward lesser length of stay and lower readmission rates in RA surgery between its introduction in 2011 and present-day can also be seen. Further research experiments can analyze a greater patient database as the use of RA surgery rises, and this type of research can also be introduced into other departments of robotic surgery. RA surgery is emerging as a rivaling technique to VATS, and as it develops it has the capacity to surpass VATS by becoming more reliable and more cost-effective.
The Da Vinci Surgical System. Digital image. The Expert Institute. The Expert Institute Group, LLC, 1 Apr. 2013. Web. 22 July 2013.
Dr. Szwerc, Michael F. Personal interview.
Robot Diagram. Digital image. Unity Point Health. St. Luke's Hospital, 2013. Web. 23 July 2013. .
Published In/Presented At
Werner, A., Szwerc, M., & Langston, K. (2013, July 26). A Comparsion of Robotic- Assisted Thoracic Lung Surgery with Open Lung Surgery and Video-Assisted Thorascopic Lung Surgery. Poster presented at: Research Day 2013, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters
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