机器人辅助胸腔镜手术（RATS）与电视胸腔镜术辅助手术（VATS）的比较

机器人辅助胸腔镜手术（RATS）与电视胸腔镜术辅助手术（VATS）的比较

回顾性分析，安全性和住院时间的比较
Robotic vs Video-Assisted Thoracoscopic Surgery: A Retrospective Analysis of Safety and Length of Stay

Purpose
In 2022, robotic-assisted thoracoscopic surgery (RATS) was adopted, for lung and mediastinal resections, at our Canadian tertiary care thoracic surgery center.1,2 This study compares the safety and length of stay (LOS) outcomes of the RATS approach with the current standard of care: video assisted thoracoscopic surgery (VATS).
Methods
Data were identified and collected from the institution's electronic medical record on RATS and VATS lung and mediastinal cases performed between 2022-2024. Median and interquartile ranges (IQR) were calculated for continuous variables and proportions were calculated for categorical variables. Multiple linear regression was performed to assess the impact of RATS vs VATS on length of stay, while controlling for covariates (age, sex, Charlson Comorbidity Index, lung cancer stage, ECOG, DLCO, FEV1, conversion to VATS/open, surgeon). Adverse event rates, including prolonged air leak rates were calculated for both groups, and compared using a chi-squared test.
Results
We performed 119 RATS and 390 VATS lung resections (Table 1). The median LOS was 3 days (IQR: 1- 5) in the RATS group and 2 days (IQR: 1-5) in the VATS group, with no significant difference on multiple linear regression. 11% (13/119) of RATS cases were converted, all non-urgently, (9% to VATS (11/13) and 2% to open (2/13)) compared to 3% (13/390) of VATS cases. The rate of adverse events was 29% (35/119) in the RATS group and 39% (153/390) in the VATS group, with no significant difference. The rate of prolonged air leak was 15% (18/119) in the RATS group and 17% (65/390) in the VATS group, with no significant difference. We performed 41 RATS mediastinal and 19 VATS mediastinal resections. The median LOS was 1 day (IQR: 1-2) in the RATS group and 2 days (IQR: 2-5) in the VATS group, which was significantly different (p<0.05) on multiple linear regression. 10% (4/41) of RATS cases were converted, all non-urgently, (2% to open (1/4), 8% to VATS (3/4)) compared to 5% (1/19) of VATS cases. The rate of adverse events was 29% (12/41) in the RATS group and 26% (5/19) in the VATS group, with no significant difference.
Conclusions
Both RATS and VATS approaches were equivalent in regards to safety, during the initial adoption of RATS, at a Canadian tertiary care center. For mediastinal cases, the RATS approach reduced LOS by 1 day. Further work is required to elucidate possible differences in surgical quality and adverse event rates.

Nikita Arora (1), Rena Seeger (2), Caitlin Anstee (2), Angie Stackhouse (2), Daniel Jones (3), Sebastien Gilbert (1), Patrick Villeneuve (4), (1) University of Ottawa, Ottawa, ON, (2) University of Ottawa, Ottawa, NA, (3) The Ottawa Hospital, Ottawa, Ontario, (4) N/A, Ottawa, ON