Comparison of pulmonary lobectomies using robotic and video-assisted thoracoscopic approaches: results from 2010-2013 National Inpatient Sample

BACKGROUND: Robotic lobectomies for pulmonary pathologies, such as lung cancer, have seen increased usage over the past 10 years. Previous studies have shown that robotic lung surgery is safe and can lead to improved outcomes for patients. The purpose of this study was to compare postoperative complications associated with robotic lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy using the National Inpatient Sample (NIS) database in the USA. The use of this large, nationwide database may help clarify differences in outcomes of these two operative approaches. METHODS: Patients who underwent VATS and robotic lobectomy from 2010-2013 were identified using the NIS database. A propensity score snatched analysis was applied in a 1:1 ratio to minimize imbalance between preoperative comorbidities. RESULTS: Final analysis included a total of 2868 patients: 1434 were VATS and 1434 were robotic cases. Postoperatively, the rate of overall morbidity was not statistically different in the VATS versus the robotic group (39.9% vs. 43.0%, P=0.084). Specific complications that were higher in the robotic group included: rates of accidental puncture or laceration (1.8% vs. 0.8%, P=0.016), pneumonia (5.7% vs. 4.1%, P=0.048), and bleeding complications (2.4% vs. 1.1%, P=0.012). Total costs were lower for the VMS group than the robotic group ($77,940.54 vs. $102,057.07, P<0.001). CONCLUSIONS: Overall morbidity between the two groups was not statistically different. Patients that underwent robotic versus VATS lobectomy were significantly more likely to experience accidental puncture or laceration, pneumonia, and bleeding complications. Robotic surgery also incurred more cost.