D. Shehata1, C. Digesu2, C. Vigna1, E. Lopez1, C. Stock1, E. Servais1, A. Watkins1 1Lahey Hospital and Medical Center, Division Of Thoracic And Cardiovascular Surgery, Tufts University School Of Medicine, Burlington, MA, USA 2Boston Medical Center, Department Of Thoracic Surgery, Boston University Chobanian & Avedisian School Of Medicine, Boston, MA, USA
Introduction: Spontaneous pneumothorax is a common thoracic surgical problem. Blebectomy combined with mechanical and chemical pleurodesis techniques have historically been used as the initial measure to prevent recurrence, however recurrence remains high. We report the first series of robotic-assisted pleurectomy (RAP). A safe and effective surgical treatment for spontaneous pneumothorax.
Methods: A retrospective, single-center analysis was conducted on consecutive patients undergoing RAP for spontaneous pneumothorax from 2017 to 2023. Patients with prior surgery on the same side for pneumothorax were excluded. Demographics, comorbidities, functional status, intra-operative variables, and peri-operative complications were collected. In addition, 30-day re-admission, 30-day mortality, and evidence of recurrence as confirmed by imaging was recorded.
Results: We identified 36 patients undergoing RAP during the study period with a median follow-up of 12 months. Patients had a mean age of 44 ± 23.1 years and were mostly male (80.6%) and current smokers (51.7%) with 63.9% having a primary spontaneous pneumothorax. Total median operative time was 100 minutes. Patient postoperative outcomes are presented in Table 1. Median time to chest tube removal was 3 days (IQR 2-3) and the median length of stay was 2 days (IQR 2-4). Complications occurred in 19.4% of patients with the majority having a grade 2 Clavien-Dindo classification score. Grade 2 complications included urinary tract infection and wound infection requiring antibiotics, atrial fibrillation, blood transfusion, and pneumonia. Two patients had persistent air leak and were discharged with a chest tube. One patient had a grade 3b complication requiring return to the operating room for acute hemothorax. One patient was readmitted for pleural effusions related to heart failure. There was no 30-day mortality. There was one asymptomatic recurrent pneumothorax which occurred one year post-operatively and did not require intervention.
Conclusion: Robotic-assisted pleurectomy for spontaneous pneumothorax is a safe and effective operation that can be used as first line treatment to prevent future recurrence. Prospective comparison between RAP and alternative interventions is needed.
