A community hospital's experience with robotic thoracic surgery.

Introduction: The emergence of minimally invasive thoracic surgery has positively impacted postoperative recovery. Robotic-assisted thoracoscopic surgery (RATS) has been shown to have equivalent short- and long-term outcomes as compared with video-assisted thoracoscopic surgery (VATS). The introduction of RATS offers a three-dimensional high-definition image, improved ergonomics, and wristed movement. The purpose of this paper was to define the learning curve of RATS.

Methods: This study is a retrospective review of a single surgeon's RATS experience in a community hospital. All patients who underwent RATS between December 2011 and April 2014 were included. The cohort was divided into 2 groups: "early" and "late." These groups were created based on the date before or after February 2013, respectively. Data is presented as means and percentages. Significance was defined as a value < 0.05. All categorical variables were evaluated with Fisher's exact test and all continuous variables were compared via a paired test.

Results: Seventy-nine patients were identified with a mean age of 59. There were 39 patients in the early group and 40 in the late. Rates of conversion to open thoracotomy (13% vs 10%,  = 0.74) and operative time (180 vs 204 min,  = 0.34) did not demonstrate any statistical significance between the two cohorts. Postoperative morbidity (21% vs 28%,  = 0.60) and mortality (3% vs 0%,  = 1.00) were equivalent between both groups. There was a higher percentage of lobectomies performed during the late group (38% vs 65%,  = 0.02). Furthermore, these lobectomies were performed at a faster rate in the late group.

Conclusion: Based on our experience, the complexity of the operations that can be performed robotically increased with the number of operations performed without an impact on postoperative morbidity and mortality.