What are the statistics for complications associated with robotic lobectomy (lung resection)?

From the Guidelines

Robotic lobectomy has complication rates comparable to or lower than traditional open approaches, with major complications occurring in approximately 10-15% of cases and mortality rates under 1%. The most recent and highest quality study, published in 2021 1, found that thoracoscopy, which includes robotic lobectomy, has a lower total postoperative complication rate compared to thoracotomy. Common complications of robotic lobectomy include:

• Prolonged air leak (5-10%)
• Atrial fibrillation (10-15%)
• Pneumonia (3-5%)
• Conversion to open surgery is necessary in 5-10% of procedures
• Bleeding complications requiring transfusion occur in 2-4% of cases
• Other potential complications include wound infections (1-3%), recurrent laryngeal nerve injury (1-2%), and chylothorax (1%) Hospital stays average 3-5 days, significantly shorter than open lobectomy. Robotic approaches offer benefits of minimally invasive surgery, including reduced pain, smaller incisions, and faster recovery, while maintaining oncologic outcomes equivalent to open surgery. Patient selection is important, with obesity, extensive pleural adhesions, and large tumors potentially increasing complication risks. Surgeon experience significantly impacts complication rates, with higher-volume centers typically reporting better outcomes as the learning curve is overcome 1.

From the Research

Robotic Lobectomy Complications

• The risk of pulmonary complications after robotic lobectomy is lower compared to open lobectomy, with a significant reduction in prolonged air leak, atelectasis, and pneumonia 2.
• Robotic lobectomy has been shown to decrease the risk of postoperative pulmonary complications, particularly in patients with limited pulmonary function 2.
• A network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach for pulmonary lobectomy found that robotic lobectomy had significantly reduced 30-day mortality, pulmonary complications, and overall complications compared to open lobectomy 3.
• The learning curve for robotic lobectomy is relatively short, with significant improvements in operative time and conversion rate after the initial 20 cases 4.
• A study analyzing 5721 cases of open, robotic, and thoracoscopic lobectomy found that robotic-assisted lobectomy had shorter operative time, lower conversion rate, and shorter hospital stay compared to video-assisted thoracic surgery and open lobectomy 5.

Comparison of Robotic Lobectomy to Other Approaches

• Robotic lobectomy has been compared to video-assisted thoracic surgery and open lobectomy in several studies, with findings suggesting that robotic lobectomy has favorable perioperative outcomes, including reduced length of stay and decreased conversion rate 3, 5.
• A study found that robotic lobectomy and video-assisted thoracic surgery had similar postoperative complication rates, but robotic lobectomy had a lower conversion rate and shorter hospital stay 5.
• Robotic lobectomy has been shown to have equivalent oncologic outcomes and 5-year overall survival compared to open lobectomy and video-assisted thoracic surgery 3, 6.

Patient Selection and Outcomes

• Patients with limited pulmonary function may derive the most benefit from robotic lobectomy due to its minimally invasive approach and reduced risk of pulmonary complications 2.
• Robotic lobectomy has been shown to be safe and effective for patients with early-stage lung cancer, with favorable perioperative outcomes and equivalent oncologic outcomes compared to other approaches 3, 5.
• The selection of patients for robotic lobectomy is similar to that for video-assisted thoracic surgery, with consideration of factors such as age, sex, and tumor stage 6, 5.