{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T06:49:48Z","timestamp":1781333388665,"version":"3.54.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T00:00:00Z","timestamp":1726099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The aim of this study was to evaluate the impact of the thoracic robotic approach in a high-volume center regarding procedures and clinical outcomes after 1,000 procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a single-center subset of the Epithor\u00ae database, a prospective cohort database of French thoracic surgery, we analyzed procedural characteristics and clinical outcomes from February 2014 to April 2023. A surgical technique for lung surgery was conducted with a four-arm closed chest with the port access approach and vascular sewing and knotting were preferred over stapling. Statistical analysis was performed using the Chi-2 test for discontinuous variables and the Mann\u2013Whitney\u2013Wilcoxon test for continuous variables. Tests were considered significant for a <jats:italic>p<\/jats:italic>-value &amp;lt;0.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Robotic thoracic surgery was used in anatomical lung resection in 85% of the cases. Over the study period, 1,067 patients underwent robotic surgery, of which 509 had lobectomies and 391 segmentectomies. In the segmentectomy group vs. lobectomy group we observed a shorter length of stay (9\u2009\u00b1\u20097 vs. 7\u2009\u00b1\u20095.6 days, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), a shorter surgery time (99\u2009\u00b1\u200924 vs. 116\u2009\u00b1\u200938\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) a lower conversion rate (<jats:italic>n<\/jats:italic>\u2009=\u20092 vs. <jats:italic>n<\/jats:italic>\u2009=\u200917, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), and a lower complication rate (28% vs. 40%, <jats:italic>p<\/jats:italic>\u2009=\u20090.009, mainly Clavien\u2013Dindo II, 18% and 28%, respectively). For cancer treatment surgery, we found more previous cancer in the segmentectomy group (48% vs. 26%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). We also observed a progressive change of lobectomy vs. segmentectomy from 80%\/20% to 30%\/70% over the 9\u2005years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>A robotic platform is an appropriate tool to perform anatomical lung resection and especially to develop a safe and systematic approach to lung-sparing sub-lobar resection.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2024.1417787","type":"journal-article","created":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T06:58:29Z","timestamp":1726124309000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Robotic thoracic surgery: lessons learned from the first 1,000 procedures"],"prefix":"10.3389","volume":"11","author":[{"given":"Marion","family":"Durand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee S.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frankie","family":"Mbadinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maksim","family":"Pryshchepau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadrien","family":"Portefaix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouha","family":"Chaabane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas","family":"Ropert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naziha","family":"Khen-Dunlop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/S0096-5588(20)31576-2","article-title":"The surgical management of carcinoma of the lung","volume":"20","author":"Churchill","year":"950","journal-title":"J Thorac Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/0003-4975(95)00537-U","article-title":"Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer","volume":"60","author":"Ginsberg","year":"1995","journal-title":"Ann Thorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"203S","DOI":"10.1378\/chest.112.4_Supplement.203S","article-title":"Resection of non-small cell lung cancer","volume":"112","author":"Ginsberg","year":"1997","journal-title":"Chest"},{"key":"B4","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/SLA.0000000000002346","article-title":"Robotic versus video-assisted lobectomy\/segmentectomy for lung cancer: a meta-analysis","volume":"268","author":"Liang","year":"2018","journal-title":"Ann Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jtcvs.2011.10.055","article-title":"Robotic lobectomy for non\u2013small cell lung cancer (NSCLC): long-term oncologic results","volume":"143","author":"Park","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1016\/j.jtcvs.2011.07.022","article-title":"Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms","volume":"142","author":"Cerfolio","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1016\/j.athoracsur.2008.02.085","article-title":"Robot-assisted thoracoscopic lobectomy for early-stage lung cancer","volume":"85","author":"Gharagozloo","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jtho.2020.09.012","article-title":"Lung cancer in France","volume":"16","author":"Pujol","year":"2021","journal-title":"J Thorac Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.athoracsur.2014.02.051","article-title":"Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes","volume":"98","author":"Nasir","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1056\/NEJMoa2212083","article-title":"Lobar or sublobar resection for peripheral stage IA non\u2013small-cell lung cancer","volume":"388","author":"Altorki","year":"2023","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"ezad224","DOI":"10.1093\/ejcts\/ezad224","article-title":"European society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer","volume":"63","author":"Brunelli","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"286","DOI":"10.21037\/acs.2018.11.02","article-title":"Four-arm robotic sleeve right upper lobectomy","volume":"8","author":"Durand","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"40","DOI":"10.21037\/jovs.2020.03.02","article-title":"Four arm robotic double right segmentectomies S3 & S7\u201310 with fluorescence lung mapping","volume":"6","author":"Durand","year":"2020","journal-title":"J Vis Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"4197","DOI":"10.21037\/jtd-2022-16","article-title":"Anatomical resection of colorectal lung metastases: a reasonable indication without evidence\u2014non-systematic and incomplete reporting is a key issue","volume":"14","author":"Welter","year":"2022","journal-title":"J Thorac Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"ezw322","DOI":"10.1093\/ejcts\/ezw322","article-title":"Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer","volume":"51","author":"Shiono","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/S2213-2600(18)30411-9","article-title":"Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB\/alliance 140503)","volume":"6","author":"Altorki","year":"2018","journal-title":"Lancet Respir Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1093\/ejcts\/ezy166","article-title":"Robotic resection of stage III lung cancer: an international retrospective study","volume":"54","author":"Veronesi","year":"2018","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1417787\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T06:58:32Z","timestamp":1726124312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1417787\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,12]]},"references-count":19,"alternative-id":["10.3389\/fsurg.2024.1417787"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2024.1417787","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,12]]},"article-number":"1417787"}}