Perioperative outcomes of RATS pulmonary lobectomy for lung cancer and tuberculosis in a learning curve setting

Abstract

<b>Background:</b> VATS lobectomy– is a routine surgical procedure for pulmonary tuberculosis (TB) and lung cancer (LC) patients, today. Nevertheless, VATS lobectomy is associated with a longer learning curve because of its inherent basic limitations. The robotic surgical system developed essentially to overcome these limitations. The aim of this study is to compares perioperative outcome of RATS pulmonary lobectomy for LC and TB in a learning curve setting. <b>Methods:</b> Prospective clinical trial from May 2013 to January 2015. 47 consecutive patients were selected for RATS lobectomy. Two groups of patients: 1) with localized forms of cavitary pulmonary TB; 2) with LC. <b>Results:</b> 31 patients with cavitary pulmonary TB and 16 patients with LC were underwent RATS lobectomy. Total/console mean operative time was 204/137 min. and 252/200 min. in 1^st and 2^nd group, respectively. Intraoperative blood loss was less in TB-cases (135 vs 259 ml). Learning curve of RATS lobectomy showed progressive decline of operation time in lung cancer patients and irregular shape of thelearning curve in TB-cases due to higher frequency of pleural adhesions. There was less rate of postoperative morbidity and prevalence of non-threatening complications of life after the 20^th operation. Rate of perioperative morbidity was 17% and 12% in 1^st and 2^nd group, respectively. <b>Conclusion:</b> RATS lobectomy for cavitary pulmonary TB is effective and safety as well as for LC. Main key parameter that affects learning curve of robotic lobectomy in TB-cases is preoperative evaluation of pleural adhesions, in LC-patients – is the volume of lymphadenectomy. Postoperative morbidity is reduced to a minimum after 20^th operations.