Comparison of Two-Port and Three-Port Approaches in Robotic Lobectomy for Non-Small Cell Lung Cancer

Background: Robot-assisted lobectomy has been used to treat non-small cell lung cancer and usually uses 3 or 4 ports and 3 or 4 robotic arms. We recently developed a two-port approach for robotic lobectomy using three robotic arms and performed a propensity score-matched analysis to compare the feasibility of the two-port and three-port techniques. Methods: Data on robotic lobectomy for non-small cell lung cancer were retrospectively reviewed. Patients were matched using propensity score based on age, sex, smoking, diabetes, hypertension, forced expiratory volume per 1 s, neoadjuvant chemotherapy, clinical stage, lobe involved, tumor size, and cell types. Overall, 53 and 89 patients who underwent the two-port and three-port approaches, respectively, were matched (1:1 ratio; caliper distance, 0.2). We analyzed the perioperative outcomes and postoperative pain to evaluate the feasibility and safety. Results: The matched group included 37 patients each who underwent two-port and three-port robotic lobectomy. The operation time was shorter in the two-port group (P =.01). The number of lymph nodes resected (P =.70), conversion to multiport or thoracotomy (P >.99), morbidity and mortality (P =.31), drain indwelling time (P =.32), and hospital stay (P =.11) were not significantly different between the groups. The postoperative pain was less at 0–3 postoperative days (P <.01) in the two-port group. The total medical cost was not markedly increased after transitioning to the two-port technique. Conclusions: Two-port approach in robotic lobectomy is a safe and feasible alternative approach for treating non-small cell lung cancer.