• robotica
• DaVinci
• Chirurgia

Purpose. The main end point of the study was to compare the surgical performance of robot-assisted pulmonary lobectomy with open (thoracotomy) lobectomy for clinical stage I (T1a N0 – T2a N0; T <5 cm) non-small cell lung cancer (NSCLC). Secondary end points were description of short and mid-term clinical outcomes of the robotic procedure, in particular in terms of pain perception and quality of life.
Methods. A retrospective analysis of prospectively collected data was performed, concerning totally endoscopic robotic lobectomies (RL) performed between January 2011 and December 2013 on 86 patients for Stage I NSCLC. The robotic procedures were conducted employing a four-arm robotic device (Da Vinci Robotic System) through a five port minimally invasive access (a fifth utility port was needed for insertion of suction devices and gauze placement). After lobectomy, a systematic lymphadenectomy was performed in all cases. The surgical outcomes were subsequently compared to a cohort of 160 patients who afforded standard “open” lobectomy (OL) in the same period, and the data were matched to the robotic group using propensity scores for a series of pre-determined preoperative variables.
Results. Clinical and pathologic characteristics were similar between the two groups. Conversion from robotic to open surgery was necessary in 4 cases. Median operating time was 168 min (110 – 308 min) for robotic procedures and 122 min (97 – 145 min) for open procedures. Median number of lymph nodes removed and rate of major complication were similar in the 2 groups. Pain perception in the first three post-operative days was significantly lower in the robotic cohort. Median postoperative drainage and hospitalization time were similar between two groups. Quality of life, determined by the Short Form Health Survey (SF 12), was evaluated after 4 weeks from surgery. A better average mental and physical health perception was evidenced in the RL group as compared to OL (Mental: 56.2 vs 39, p = 0.01; Physical 43.8 vs 32.1, p = 0.04).
Conclusions. Robotic lobectomy with lymph node dissection for clinical stage I lung cancer proved to be equal to open lobectomy in terms of surgical performance. Furthermore, robotic approach allows a faster recovery with a long lasting limitation of pain perception, improvement of quality of life and faster return to the preoperative activity level.