Assessment of factors responsible for successful establishment of a successful robotic assisted thoracic
surgical program at a community hospital
Divyakant B. Gandhi, MD FACS FRCS; Kathleen Elwood, RNFA
Ingham Regional Medical Center, Lansing, MI
Objective:
Successful implementation of new technology to perform conventional thoracic surgical procedures
traditionally requires large volume of similar operations performed usually at a center with a large
referral base and caseload. We examine the factors responsible for our success in implementing Robotic
Assisted technology to perform minimally invasive Thoracic surgery in a small community hospital with a
240 bed capacity.
Methods:
From August 2008 to August 2010 we performed 74 minimally invasive Robotic Assisted Thoracic
Surgical procedures as follows:
- Robotic Takedown of IMA with Mini-thoracotomy & Single Vessel Off Pump CABG - 5
- Robotic Lobectomy with Mediastinal Lymph Node Dissection(MLND) - 22
- Robotic Radical Thymectomy for Myasthenia Gravis - 4
- Robotic Heller Myotomy via Abdominal approach - 4
- Repair of Paraesophageal Hernia via Abdominal approach - 6
- Wedge Resection of Pulmonary Lesions with or without MLND - 34
Results:
Mortality 0%; Average Length of stay 5.6 days (Range: 3-26); Postop Pneumonia 0; Intraop or Postop
Bleeding requiring thoracotomy 0; Prolonged Air Leak beyond 4 days 0; Blood Transfusions 0; Postop
transient Paraparesis 1; Conversion to conventional Thoracotomy 4 in 1st 10 Lobectomies and One in the
next 12 Lobectomies; Prolonged Gastric Ileus 1.
Conclusions:
The factors responsible for establishment of a successful Robotic Thoracic Surgical program in small
volume community hospital include:
- Careful initial planning with an initial conscious decision not to perform any heart surgeries
requiring institution of cardiopulmonary bypass.
- Focus maintained on carefully evaluating the available literature and carefully choose the
various non Cardiac Thoracic Procedures amenable to Robotic Assisted technology.
- Not hesitate to implement the technology in any suitable procedure after careful study despite
unfamiliarity e.g.: Heller Myotomy and Repair of Paraesophageal Hernia.
- Develop and emphasize team spirit, emphasis on detail in all phases of the procedure.
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