OBJECTIVE Robot-assisted thoracic surgery (RATS) is becoming increasingly popular due to technological advancements that enhance surgical outcomes. RATS was introduced at The Ottawa Hospital in 2022. This study aims to assess surgeon performance over time by analyzing learning curves for surgical efficiency and evaluating safety. METHODS Ethics approval was obtained for a prospective registry of all robotic cases. We analyzed 170 consecutive RATS procedures (April 2022 to November 2024) and 340 time-matched video-assisted thoracoscopic surgery (VATS) procedures. Descriptive statistics were calculated in Excel. Learning curves and operative times for lobectomies and anterior mediastinal resections were assessed using CUSUM analysis in R, with console time as a surrogate. Safety was evaluated using the Ottawa Thoracic Morbidity and Mortality schema for adverse events. RESULTS The mean console time for all cases (N = 144) was 126 min, with a mean docking time of 24 min. For both lobectomies and anterior mediastinal resections, the acquisition of procedural efficiency was achieved after 20 cases and 7 cases, respectively. Safety outcomes were comparable to VATS, with most (n = 43, 73%) being grade II prolonged air leak (n = 19, 32%). Conversions to VATS occurred in 14 cases (8%), primarily due to complex anatomy, with only 3 cases (2%) converted to open. No conversions were done urgently. CONCLUSIONS The introduction of RATS is safe, with procedure efficiency being achieved within a reasonable number of cases.
Objective: Diaphragmatic eventration is characterized by the elevation of a hemidiaphragm. This condition may impair pulmonary function, leading to dyspnea, reduced exercise tolerance, and dramatic deterioration in quality of life. Diaphragmatic plication represents the mainstay of treatment. The aim of the study is to compare the postoperative results of plication performed using robot-assisted thoracic surgery (RATS) and the open thoracotomy approach. Methods: Between January 2019 and January 2024, 50 consecutive patients affected by diaphragmatic eventration underwent surgical plication at 2 centers. The sample was divided into RATS and open surgery groups. Clinical characteristics, early and late complications, recurrence, postoperative pain, length of hospital stay, chest tube duration, and cosmetic results were retrospectively analyzed. Surgical techniques and outcomes were compared between the 2 groups. Results: The median operative time of RATS (including docking–undocking time) was longer than in the thoracotomy group. Chest tube duration was longer in the open group, despite no statistical significance in multivariable analysis. No conversion rate was reported in the RATS group. Postoperative pain at 24 h ( P < 0.001) and 4 weeks ( P < 0.001) was significantly lower in the RATS group. Improved cosmetics results were reported after RATS, compared with the open approach ( P < 0.001). Improvement in postoperative forced expiratory volume in 1 s was significantly greater in the RATS group ( P = 0.016). Conclusions: To the best of our knowledge, this is the first multicenter study providing a comparative analysis between the different surgical techniques. With the limit of a retrospective analysis, our study reports promising results for RATS diaphragmatic plication. Advantages in terms of postoperative pain, cosmetic results, and functional recovery support RATS over the open approach.
