Robot-assisted thoracic surgery (RATS) is a recognised alternative to video-assisted thoracic surgery (VATS) but remains under utilised in the UK. We describe the establishment of a RATS lobectomy service, outlining peri-operative outcomes and learning curve trends. We retrospectively analysed peri-operative variables, post-operative complications, and learning curve progression in patients undergoing RATS lobectomy. Outcomes assessed included operation time, length of stay, complication rates, and composite technical failure (conversion, reoperation, or peri-operative death). Learning curve analysis was performed using grouped sequential cases and cumulative sum (CUSUM) methodology. Between June 2022 and December 2024, 140 patients 60M:80F, median age 71 (range 42–86) underwent RATS lobectomy by one surgeon. Median FEV1, FVC, and DLCO were 95.6%, 106%, and 81.3%, respectively. Eighty-nine cases (63.6%) were right-sided, with a median operative time of 125.5 minutes. Four patients (2.9%) required conversion (three due to adhesions, one due to bleeding). Median air leak duration was 2 days, and median hospital stay 4 days. Thirty-three patients (23.6%) developed complications: chest infection (9.3%), respiratory failure (1.4%), sepsis (1.4%) and cerebrovascular accident (0.7%). Three patients (2.1%) required re-exploration. There were two 30-day and one 90-day mortalities, but no intraoperative mortalities. Learning curve analysis demonstrated significant improvement in operative time (p < 0.001), with proficiency achieved after 59 cases. Composite technical proficiency was achieved after 79 cases. RATS lobectomy was safely established with low conversion and acceptable morbidity. Structured preparation, proctor involvement, and multidisciplinary engagement facilitated safe adoption, while efficiency improved without compromising safety.
Lee et al. (Fri,) studied this question.