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Is Robotic-Assisted Thoracoscopic Lobectomy (RATL) Better than Video-Assisted Thoracoscopic Lobectomy (VATL)
*Brian G A Dalton, *Paul A Perry, *Robert B Hird, Richard K Orr, *Christophe L Nguyen
Spartanburg Regional Medical Center, Spartanburg, SC

Objective: Comparison of robot assisted (RATL) and video assisted (VATL) techniques of pulmonary lobectomy.
Design: Retrospective cohort study.
Setting: Tertiary referral center with a community cancer center and a general surgery residency.
Patients: Thirty four consecutive patients that underwent RATL compared to 34 previously performed consecutive VATL patients.
Interventions: Pulmonary lobectomy either robot or video assisted, performed by a single surgeon with first assistance from general surgery residents.
Main Outcome Measures: Length of stay (LOS), chest tube (CT) days, average lymph node (LN) yield, operative time, estimated blood loss (EBL), complication rate.
Results: Patient characteristics were similar among the two groups. RATL was successfully completed in 30 of 34 patients (88%) with 3 patients converted to thoracotomy and one to VATL. No patients in the VATL group required conversion. The majority of interventions were performed for NSCLC (82% of the RATL group and 88% of the VATL group) All lobectomies performed for NSCLC in both groups were margin negative. Please see table 1 for further comparison of RATL and VATL groups.
Table 1: Peri-operative data for RATL vs VATL
ValueRATL (n=34)VATL (n=34)p value
LOS (days)5.6 +/- 3.76.7 +/- 3.50.10
CT duration (days)3.0 +/- 0.94.3 +/- 3.20.05
Average LN Yield12.6 +/- 7.37.7 +/- 4.10.002
Operative Time (min)298 +/- 67246 +/- 70NS
EBL (ml)143 +/- 291171 +/- 159NS
Complication Rate (%)2127NS
30 day Mortality Rate (%)02.9NS

Conclusion: The use of RATL for early stage NSCLC appears safe and feasible. Comparison of our early RATL data with our established VATL data suggests advantages of improved LN yield, shorter CT days and shorter LOS with RATL. RATL appears to be at least oncologically equivalent and possibly superior to VATL.

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