Faculty Bibliography

The da Vinci 5 (DV5) system has purported advantages over existing platforms, including forced feedback. We compare perioperative safety, operative efficiency and early oncologic quality between DV5 and Xi robotic platforms for anatomic lung resection. A total of 419 robotic lung resections were performed between January 2025 and August 2026. Propensity-score overlap weighting balanced and matched 294 patients (47 DV5, 247 Xi) for age, sex, ASA class, BMI, forced expiratory volume in 1 s, tumor size, clinical T and N category, resection type and laterality. Effects were reported with robust and bootstrap 95% confidence intervals. Sensitivity analyses included 1:1 and 1:3 propensity matching comparisons and E-value assessment. From January 2025 to August 2026, 294 patients (47 DV5, 247 Xi) had balanced baseline characteristics (SMD < 0.01). Operative time was shorter with DV5 (96.4 vs. 118.7 min; 95% CI, - 36.2 to - 8.5). Lymph node yield was comparable (DV5 29.9 vs. Xi 31.6; [- 7.2 to + 3.7]). Blood loss (p < 0.01), length of stay (1.05 vs. 1.28 days; [- 0.53, + 0.06]) and stapler loads (8.5 vs. 9.6; [- 2.81 to + 0.55]) were numerically lower with DV5. Major complications were numerically lower with DV5 (1/47 [2.0%] vs. 20/247 [8.2%]; -16.0 to + 3.6). Both had 100% R0 resections and no conversion. There was no 30- or 90-day mortality. In this first clinical comparison of da Vinci 5 and Xi for robotic anatomic lung resection, DV5 preserved the safety and oncologic quality of Xi while being associated with shorter operative times. Prospective multi-institutional studies are required to confirm these findings.

BACKGROUND:The new SP (Single-Port) robotic system is increasingly used for thoracic surgery. METHODS:A retrospective analysis of consecutive patients who underwent extra-thoracic, single-incision surgery, using the SP robotic system between December 2024 and January 2026. RESULTS:From September 2024 to January 2026, 82 patients (44 women) underwent SP robotic thoracic surgery. The median height was 165.1cm (5'5"), median BMI was 26.6. Types of operations were: thymectomy (n=28), lobectomy (n=32), segmentectomy (n=17), and pulmonary wedge resection (n=5). Median operative time for thymectomy was 101 minutes and 137 minutes for lung resection. Median chest tube duration for thymectomy was 0 h and was 7.3 h in the 54 patients who underwent pulmonary resection. Median actual blood loss of 20cc (range 15 - 40). Median hospital length of stay was 1 day for all. Median lymph node count was 29 in the right chest and 23 in the left (median of 5 N2 and 3 N1 stations). All had R0 resections. The new SP robotic stapler, used in the last 38 patients, had no malfunctions. No patient experienced major complications (Clavien-Dindo grade > IIIa). There was no 30- or 90-day mortality and the readmission rate within 60 days was 1%. CONCLUSIONS:This initial experience, the largest report outside of South Korea, shows that robotic thoracic surgery using the da Vinci single-port robotic surgical system, with the new SP robotic stapler is feasible and safe for thymectomy and complex anatomic lung resections, including lobectomy and segmentectomy.

BACKGROUND/UNASSIGNED:Minimally invasive pneumonectomy via robotic or video-assisted platforms is not yet widely adopted. Rates of conversion-to-thoracotomy and 90-day mortality are reported at 30%-50% and 12%, respectively. We describe our experience with the largest single-institution consecutive series of robotic pneumonectomy. METHODS/UNASSIGNED:This is a retrospective review of prospective database of a consecutive (non-selected) series of patients who underwent robotic pneumonectomy from January 2019 to December 2024 at our institution. RESULTS/UNASSIGNED:There were 21 patients (67% male) with median age 70 (range 15-79), DLCO 76% (range 48%-106%), and FEV1 76% (range 44%-126%). Indication for pneumonectomy was cancer in 17 patients (81%), of which 15 (88%) had a primary lung cancer. Four patients (19%) had destroyed lung from infection, and six (29%) underwent completion pneumonectomy. Thirteen (76%) of the 17 cancer patients had neoadjuvant therapy, including chemotherapy (11 patients), immunotherapy (10 patients), and radiation therapy (6 patients). A robotic approach was selected for all patients, with planned conversion-to-open in two patients (9%). There were no intraoperative transfusions. Median chest tube duration was one day (range 1-4). Median length of stay was five days (range 1-25). Thirty-day readmission was 19% (4 patients). Thirty-day morbidity was 19%, including atrial fibrillation in two patients, hemothorax in one patient, and chylothorax in one patient. Thirty-day mortality was 0% and 90-day mortality was 5% (one patient). CONCLUSION/UNASSIGNED:Pneumonectomy can be performed safely and effectively robotically even in high-risk patients with previous ipsilateral thoracotomy and/or neoadjuvant chemo-, immuno-, or radio-therapy. We demonstrate that a robotic approach enables minimal unplanned conversion-to-thoracotomy, no blood transfusions and excellent short-term outcomes. Our pre-, intra- and post-operative strategies are shared.

BACKGROUND/UNASSIGNED:Previous studies report a 20% conversion to open thoracotomy and 25% major morbidity rate for minimally invasive thoracic surgery following neoadjuvant chemotherapy or immunotherapy. METHODS/UNASSIGNED:This retrospective review includes a consecutive (non-selected) series of patients from two surgeons who underwent robotic resection after neoadjuvant therapy for non-small cell lung cancer. RESULTS/UNASSIGNED:From January 2018 to October 2024, 150 patients (51% male) underwent surgery following systemic therapy. The median age was 67 years. Preoperatively, 92% received chemotherapy, 65% immunotherapy, and 27% radiation. Median time from therapy to surgery was 6 weeks. The most common tumor type was stage IIIA adenocarcinoma (25%). Median operative time was 152 min, and median blood loss was 20 mL. There were no unplanned conversions to open thoracotomy or from lobectomy to pneumonectomy. Median length of stay was 1 day; 28% had chest tube removed on the day of surgery. Twenty-one patients experienced Clavien-Dindo grade III complications (primarily atrial fibrillation and effusion). There were no 30-day mortalities and two 90-day mortalities. Median follow-up was 19 months, with a median postoperative survival of 513 days. CONCLUSION/UNASSIGNED:Robotic lobectomy and pneumonectomy can be safely performed after neoadjuvant therapy, with conversion rates <1% and minimal 30- and 90-day mortality. Key technical factors include intra-pericardial control of the pulmonary artery, division of the lobar airway prior to pulmonary artery dissection, and performing surgery within 6 weeks of completing neoadjuvant therapy.

OBJECTIVES/OBJECTIVE:Evaluate impact of common pathologic features, single or in combination, in patients with early-stage lung adenocarcinoma, according to lung resection extent. METHODS:Retrospective multicentric cohort study including patients with cT1a-bN0M0 lung adenocarcinoma and with at least: visceral pleural invasion (VPI) under surface (PL1) or up to surface (PL2), lymphovascular invasion (LVI), spread through airspace (STAS), necrosis, or neural invasion, who underwent lobectomy or segmentectomy with systematic lymph nodal dissection (SND) from 2015-2021 in 10 European centers. Overall survival (OS), disease-free survival (DFS) and lung cancer specific death (LCSD) between both groups were assessed before and after stabilized inverse probability of treatment-weighting (IPTW)-matching. Risk factors for oncologic outcomes were analyzed using parsimonious model Cox proportional hazard regression in entire and multiple features datasets. Kaplan Meir and cumulative incidence function assessed outcome. Log-rank and Gray' tests compared the groups. Linearized risk assessed recurrences. RESULTS:Of 1703 patients with cT1a-bN0M0 lung adenocarcinoma, 530 had at least one poor pathological feature and 130 had multiple features. For the 530 patients, 5-year OS lobectomy 83.0%, segmentectomy 89.4%, p=0.2; 5-year DFS lobectomy 78.1%, segmentectomy 83.8%, p=0.06; and 5-year LCSD lobectomy 8.9%, segmentectomy 7.2%, p=0.6 were similar. It was the same in matched cohort. In multivariable analysis, no poor pathological feature impacted outcome more than others. Multiple poor features were not associated with any clinical, pathological trait, but impacted OS (HR:3.24, p=0.002). Locoregional recurrence (linearized risk: lobectomy 0.083, segmentectomy 0.086) was similar in matched entire dataset. CONCLUSION/CONCLUSIONS:Segmentectomy with SND dissection can be indicated in patients with stage IA1-2 lung adenocarcinoma suspected to have poor pathological features. Multiple factors were not predictable but impacted OS.

OBJECTIVE/UNASSIGNED:Mid-to-distal tracheal surgery for cancer can be safely performed minimally invasively with a one-day length of stay, avoiding a guardian chin suture, and ensuring a R0 resection in select patients. METHODS/UNASSIGNED:This is a retrospective technical review of the largest series to date of patients with mid-to-distal tracheal cancers. All were offered a right robotic approach using veno-venous extracorporeal membrane oxygenation (VV ECMO) support via percutaneous right internal jugular vein and right common femoral vein access. RESULTS/UNASSIGNED:From May 2019 to April 2024, five consecutive patients (3 men, 2 women; aged 11, 29, 37, 40, and 74 years) presented with a mid-to-distal tracheal cancer. All underwent right robotic mid-distal tracheal resections on VV ECMO for primary tracheal cancers. All patients had an end-to-end tracheal anastomosis and R0 resection and all avoided: systemic heparinization, suprahyoid release maneuvers and a postoperative guardian chin stitch. Median operative time was 258 min (range 227-292). All patients tolerated the operations well and were discharged home on the morning of postoperative day 1. There was no minor or major morbidity, no 30 or 90-day mortality, and no re-admissions. Two patients complained of cough. All had R0 resections and to date none have evidence of recurrent disease or stricture. CONCLUSION/UNASSIGNED:Resection of mid-to-distal primary tracheal cancers can be performed safely and efficiently via a right robotic approach while on VV ECMO with little to no morbidity or mortality and require only an overnight hospital stay. The techniques used to perform the operation and achieve these results are described.