The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2–5) vs. 5 (4–5.8), p = 0.005) and hospital days (4 (3–6) vs. 5 (4–6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.
RATS group was upstaged from cN0 to pN2. Among the patients in the RATS group, four individuals (13.3%) required readmission due to various reasons such as poor pain management, upper gastrointestinal bleeding, fever, and wound infection. On the other hand, in the VATS group, eight patients (22.8%) experienced readmission due to fever (two cases) as well as cardiovascular events, septic shock, pain, respiratory infection, and hemoptysis. We found that the RATS group had signicantly shorter durations of chest drainage (median of 3 days (25)) compared to the VATS group (median of 5 days (45.8)), with a p-value of 0.005 (Figure 5a). Moreover, the
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J. Clin. Med. 2024, 13, x FOR PEER REVIEW 8 of 13 the patients in the RATS group, four individuals (13.3%) required readmission due to var-ious reasons such as poor pain management, upper gastrointestinal bleeding, fever, and wound infection. On the other hand, in the VATS group, eight patients (22.8%) experi-enced readmission due to fever (two cases) as well as cardiovascular events, septic shock, pain, respiratory infection, and hemoptysis. We found that the RATS group had signi-cantly shorter durations of chest drainage (median of 3 days (25)) compared to the VATS group (median of 5 days (45.8)), with a p-value of 0.005 (Figure 5a). Moreover, the RATS group also exhibited shorter hospital stays (median of 4 days, (36)) compared to the VATS group (median of 5 days (46)), with a p-value of 0.023 (Figure 5b). Figure 4. Lymph node counts for stations. Abbreviations: RATS: robot-assisted thoracic surgery; VATS: video-assisted thoracic surgery. (a) J. Clin. Med. 2024, 13, 1653 8 of 12
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Surgical failure; n (%) 8 (26.6%) 14 (40%) 0.292 Learning curve completion; n 23 28 Conversion; n (%), causes 1 (3.3%) Oncologic causes 1 (2.8%) Firm adhesions Length of stay; days (range) 4 (36) 5 (46) 0.023 Complications; n (%) 4 (13.3%) 8 (22.8%) 0.358 Grade I; n (%) 3 grade I (persistent air leaks) 5 grade I (air leaks) Grade II; n (%) 0 3 grade II (Anaphylactic shock, chylotho-rax, bradycardia with heart block) Grade III; n (%) 1 grade III (bleeding requiring sur-gery) 0 Grade IV; n (%) 0 0 Readmission; n (%) 4 (13.3%) 8 (22.8%) 0.358 Adjusted learning curve completion; n 23 31 Operative time; minutes (range) 204 (165230) 190 (180210) 0.772
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(b) Figure 5. Comparison between days of chest tube (a) and length of stay (b) between groups. Abbre-viations: RATS: robotic-assisted thoracic surgery; VATS: video-assisted thoracic surgery. No 90-day mortality was observed in either group. There was no signicant associa-tion between the type of surgery and the occurrence of surgical failure (p = 0.29), with 8 (26.6%) in the RATS group and 14 (40%) in the VATS group. Surgical outcomes are sum-marized in Table 2. Table 2. Surgical outcomes. RATS (n = 30) VATS (n = 35) p Value Readmission causes Difficult pain control Upper Gastrointestinal Bleeding, Fever Wound Infection Fever in two cases Cardiovascular event, septic shock, pain, respiratory infection hemoptysis Days of chest drainage; days (range) 3 (25) 5 (45.8) 0.005 J. Clin. Med. 2024, 13, x FOR PEER REVIEW 9 of 13 RATS group also exhibited shorter hospital stays (median of 4 days, (36)) compared to the VATS group (median of 5 days (46)), with a p-value of 0.023 (Figure 5b).
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