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Montagne et al. Mini-invasive Surg 2020;4:17 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.74

Review Open Access

Robotic versus open and video-assisted
thoracoscopic surgery approaches for lobectomy

François Montagne , Benjamin Bottet , Matthieu Sarsam , Frankie Mbadinga , Zied Chaari , Philippe
1
1
1
1
1,2
Rinieri , Jean Melki , Christophe Peillon , Jean-Marc Baste 3
1
1
1
1 Department of General Thoracic Surgery, Rouen University Hospital, Rouen 76000, France.
2 Department of Thoracic and Cardiovascular Surgery, Habib Bourguiba University Hospital, Sfax 3029, Tunisie.
3 Normandie University, UNIROUEN, INSERM U1096, Department of General Thoracic Surgery, Rouen University Hospital,
Rouen 76000, France.
Correspondence to: Dr. François Montagne, Department of General Thoracic Surgery, Rouen University Hospital, 1 rue de
Germont, Rouen 76000, France. E-mail: francois.montagne0438@orange.fr
How to cite this article: Montagne F, Bottet B, Sarsam M, Mbadinga F, Chaari Z, Rinieri P, Melki J, Peillon C, Baste JM. Robotic
versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Mini-invasive Surg 2020;4:17.
http://dx.doi.org/10.20517/2574-1225.2019.74
Received: 30 Dec 2019 First Decision: 24 Jan 2020 Revised: 3 Feb 2020 Accepted: 6 Feb 2020 Published: 11 Mar 2020
Science Editor: Valérie Lacroix Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

More and more data are available on the benefits of minimally invasive thoracic surgery compared to open thoracic
surgery in the curative treatment of early-stage non-small cell lung cancer. However, results are conflicting, especially
when video-assisted thoracoscopic surgery (VATS) is compared to robotic-assisted thoracoscopic surgery (RATS)
for lobectomy. Our goal is to report the main results of recent systematic reviews and meta-analyses comparing
RATS, VATS, and open surgery for lobectomy. Using PubMed database, we selected systematic reviews and
meta-analyses, which compared the short-term outcomes of patients treated by RATS, VATS, or open surgery for
lobectomy. In all but one of the systematic reviews, robotic lobectomy allowed similar short-term outcomes as VATS
lobectomy and better short-term outcomes than open surgery. One meta-analysis by O’Sullivan et al. found that
robotic lobectomy was associated with fewer adverse events (P < 0.00001) and lower 30-day mortality (P = 0.001),
compared to VATS lobectomy. Robotic lobectomy could be a valid alternative to VATS and open lobectomy. Short-
term outcomes do not appear to be different between VATS and RATS cohorts, except in one recent meta-analysis,
which reported the superiority of RATS compared to VATS. Without cost analysis and randomized controlled trials
with long-term outcomes, no strong conclusions can be drawn.

Keywords: Minimally invasive surgery, robotic surgery, robotic-assisted thoracoscopic surgery, video-assisted
thoracoscopic surgery, lobectomy, lung cancer, short-term outcomes, review

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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