Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTST8. Robotic Lobectomy for the Treatment of Early Stage Lung CancerGiulia Veronesi, 1 Franca Melfi, 2 Domenico Galetta, 1 Ralph A. Schmid, 3Patrick Maisonneuve, 1 Nicole Rotmensz, 1 Fernando Vannucci, 1Raffaella Bertolotti, 1 Lorenzo Spaggiari 11. Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy;2. Department of Cardio-Thoracic Surgery, University Hospital, Pisa, Italy;3. Division of Thoracic Surgery, University Hospital, Berne, SwitzerlandInvited Discussant: Kemp KernstineOBJECTIVE: We analysed the feasibility and safety of robotic approach for the treatmentof early stage lung cancer with standard lobectomy and describe the techniqueof robotic assisted lobectomy (RAL) and mediastinal lymph node dissection (MLD).METHODS: During a 21 months period (Dec 2006–Sept 2008), 54 patientsunderwent RAL for early stage lung cancer at our Institute. The approach includedthree ports and one utility incision. Dissection and isolation of the hilar structureswas performed using the four arms Da Vinci System. Vascular and bronchial resectionswere done with the use of standard endoscopic staplers. Standard MLD wasperformed after completion of the lobectomy. The 54 patients were individuallymatched for age (±5 years), sex, stage, nodal status and forced expiratory ventilationin 1 sec with patients who underwent open lobectomy in the same instituteduring the same period and were divided into three series based on the learningcurve according to duration of surgery.RESULTS: In 7 patients (13%) conversion from RAL to open surgery was necessarybecause of absence of fissure in 5, oncological reason and anatomical reason of thechest in each one. The number of overall postoperative complications (20%, p =0.88) and the mean number of lymph nodes removed (18.1 ± 7.9 in open versus16.8 ± 7.5 in RAL, p = 0.43) were similar in both groups. The median time for RAL208
AMERICAN ASSOCIATION FOR THORACIC SURGERYdecreased by 52 minutes between the first and the last two series of interventions(p = 0.01). The median length of post-operative stay was significantly shorter afterRAL than after open interventions (4.5 days robotic in the third series vs. 6 daysopen, p = 0.006).CONCLUSION: RAL with MLD is a feasible and safe procedure. It is an acceptabletreatment for early stage lung cancer with equal results to open surgery during theearly postoperative course. The benefit in terms of postoperative pain, respiratoryfunction and quality of life are under evaluation in a prospective case control studyand oncological long term results will be evaluated.9:00 a.m. CONTROVERSIES IN CARDIOTHORACICSURGERY PLENARY SESSIONBallroom A–C, Hynes Convention CenterModerator: Alec PattersonThe Sole Pathway Leading to ABTS CertificationShould be a Comprehensive IntegratedCardiothoracic Surgery Training ProgramBeginning Directly After Medical SchoolPro: Richard H. FeinsCon: David R. JonesWEDNESDAYMorning209
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Boston - American Association for Thoracic Surgery

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