RoboticAssisted (RATS) versus Video-Assisted (VATS) lobectomy: A monocentric prospective randomized trial

INTRODUCTION

The study aim is to compare Video-Assisted (VATS) and Robotic-Assisted (RATS) lobectomy in the effort to identify advantages and limits of robotic procedures considering the high costs and specific surgeon training.

MATERIALS AND METHODS

This is a monocentric prospective randomized trial in which patients suitable for mini-invasive lobectomy were randomized 1:2 in two groups: Group A, RATS (25 patients), and Group B, VATS (50 patients). The two groups were compared in terms of perioperative and postoperative results with a mean follow up of 37.9 (±10.9) months.

RESULTS

We observed a significant reduction of pleural effusion on day 1 (140 ml vs 214, p = 0.003) and day 2 (186 vs 321, p = 0.001) for group A. The Visual Analogue Scale (VAS) showed significantly lower pain in the 1st p.o. day in group A (0,92 vs 1,17, p = 0,005). Surgery time in Group B was significantly lower (160 min vs 180, p = 0.036), but had a higher onset of atrial fibrillation and other cardiac arrhythmias (0/25 vs 9/50, p = 0.038). The OS and DFS were similar between the two groups (95.5 % vs 93.1 %, and 95.5 % vs 89.7 %, respectively). Furthermore, no statistical difference in the evaluation of quality of life during follow-up was found.

CONCLUSIONS

The RATS approach, although burdened by higher surgical costs, constitutes a valid alternative to VATS; as it determines a lower inflammatory insult, with a consequent reduction in pleural effusion, less post-operative pain and cardiological comorbidities for the patient, it can potentially determine the shortening in hospitalization. In addition, RATS allows accurate lymph node dissection, which permit to reach results that are not inferior to VATS in terms of long-term outcomes.

First case of combined robot-assisted thymectomy and transaxillary thyroidectomy: technique and robot-docking optimization

Robot-assisted thymectomy and total transaxillary thyroidectomy represent two excellent therapeutic options for functional and oncological diseases of these two organs. We report the first case in literature of combined robot-assisted resection. The patient was positioned in supine position with the left arm raised cranially 90°-120° to expose the axillary area. After completing the thymectomy we rotated 30° counter-clockwise the robot for the second surgical time. This led to an optimization of disposable instruments and a gain in terms of hospitalization and postoperative recovery for the patient. To perform these two procedures it was enough to rotate 30° the robot.