Da Vinci Xi robot decreases the number of thoracotomy cases in pulmonary resection

Minimally invasive pulmonary resection has been shown to have numerous benefits over pulmonary resection via a thoracotomy. Patients have significantly less morbidity and length of stay with video-assisted thoracoscopic surgery (VATS) compared to open thoracotomy (1-3). An analysis comparing robot-assisted surgery without the vascular stapler and open thoracotomy shows significant improvement for patients who underwent robot-assisted surgery compared to an open thoracotomy (4). The robot without a vascular stapler (da Vinci Si？, Intuitive Surgical, Sunnyvale, CA, USA) has provided surgeons with increased dexterity and improved visualization in the operative field. However, the lack of the vascular stapler has led to the reliance on a bedside assistant to help with critical parts of the surgical procedure. The addition of the robot with the vascular stapler has dramatically improved surgeon autonomy during pulmonary resections. The technological improvement of adding a vascular stapler may lead to significant improvement in the outcomes of the robot surgery compared to the VATS procedure. In addition, improved autonomy and increased dexterity and visualization has improved surgeons’ ability to perform more complex pulmonary resection using minimally invasive techniques (5). We wanted to determine if the addition of a vascular stapler (da Vinci Xi？, Intuitive Surgical, Sunnyvale, CA, USA) decreases the number of patients requiring a thoracotomy, both with cases electively performed with a thoracotomy or with cases converted to a thoracotomy from a planned minimally invasive approach