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:Robotic Ivor-Lewis esophagectomy is increasingly adopted due to its minimally invasive approach and favorable outcomes. Anastomotic leak remains the most serious complication after esophagectomy, with reported rates of 5-18%. We describe a reinforced, stapled, single-layer, thoracic anastomosis which has resulted in no leaks in 50 consecutive patients. METHODS:We performed a retrospective review of consecutive patients who underwent robotic Ivor-Lewis esophagectomy by a two-surgeon team. RESULTS:From January 2022 to February 2026, 50 patients were included with a median age of 70 years. Indications for surgery were malignancy in 47 patients, most commonly adenocarcinoma (85.1%) and benign disease in 3 patients. Median operative time was 237 min, median actual blood loss was 35 mL and median lymph node yield was 20. R0 resection was achieved in all 47 malignant cases. Complete pathologic response (pCR) was observed in 13 out of 38 patients that received neoadjuvant therapy (34.2%). There were no conversions, and median LOS was 4 days. No anastomotic leaks were detected clinically, radiographically, or biochemically and there was no 30- or 90-day mortality. At a median follow-up of 26.8 months, 1- and 2-year overall survival rates were 88.2 and 84.6%, respectively. CONCLUSIONS:This technique, when properly executed, is reproducible, safe, and can afford R0 resection and thorough thoracic lymph node dissection, with promising results. Prospective, multicenter studies are needed to compare this approach to alternative anastomotic techniques.

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:The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. METHODS/UNASSIGNED:A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. RESULTS/UNASSIGNED: = 4). CONCLUSIONS/UNASSIGNED:This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center.

BACKGROUND:Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19). METHODS:A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Secondarily, we analyzed clinical outcomes of patients requiring tube thoracostomy, including those requiring operative intervention. RESULTS:From March 1, 2020, to April 30, 2020, 118 of 1595 patients (7.4%) admitted for COVID-19 developed a pneumothorax. Of these, 92 (5.8%) required tube thoracostomy drainage for a median of 12 days (interquartile range 5-25 days). The majority of patients (95 of 118, 80.5%) were on mechanical ventilation at the time of pneumothorax, 17 (14.4%) were iatrogenic, and 25 patients (21.2%) demonstrated tension physiology. Placement of a large-bore chest tube (20 F or greater) was associated with fewer tube-related complications than a small-bore tube (14 F or less) (14 vs 26 events, P = .011). Six patients with pneumothorax (5.1%) required operative management for a persistent alveolar-pleural fistula. In patients with pneumothorax, median hospital stay was 36 days (interquartile range 20-63 days) and in-hospital mortality was significantly higher than for those without pneumothorax (58% vs 13%, P < .001). CONCLUSIONS:The incidence of secondary pneumothorax in patients admitted for COVID-19 is 7.4%, most commonly occurring in patients requiring mechanical ventilation, and is associated with an in-hospital mortality rate of 58%. Placement of large-bore chest tubes is associated with fewer complications than small-bore tubes.