P184. National Adoption of Robotic-Assisted Thoracoscopic Surgery for Oncologic Lung Resections
UMASS Medical School
Pawtucket, RI
United States - Contact Me
Dr. Jiddu Antonio Guart, MD, is a general surgery resident at the University of Massachusetts with a strong interest in advancing the field of cardiothoracic surgery. Dr. Guart is passionate about minimally invasive thoracic surgery, robotic platforms, and optimizing perioperative outcomes.
His research portfolio includes projects on chronic opioid use after minimally invasive lung resections and predictive modeling of postoperative air leaks using digital chest tube systems. Dr. Guart is also actively involved in quality improvement, addressing care delays for non-English speaking patients in emergency settings to enhance healthcare equity and efficiency.
Outside of his clinical and academic pursuits, Dr. Guart serves as the co-founder and CEO of Students & Stethoscopes, a non-profit organization dedicated to inspiring inner-city youth from low socioeconomic backgrounds to explore careers in healthcare.
Dr. Guart was a member of the team that secured a victory in the prestigious ACS Top Gun competition. He is known for his technical excellence, leadership, and dedication to improving patient care through innovation, mentorship, and compassionate practice.
Description
To analyze national trends in the adoption of robotic-assisted thoracoscopic surgery (RATS) for lung cancer resections as compared to video-assisted thoracoscopic surgery (VATS) and open approaches across different geographic regions and institution types in the National Cancer Database (NCDB).
Methods:
This is a retrospective cohort study of individuals ≥18 years in the NCDB who underwent a lung resection for non-small cell lung cancer stage I-IIIa between 2010-2021. The data was stratified by facility type (community and academic), surrounding area population (metropolitan, urban, and rural), and geographic location. Stratified linear regressions were used to calculate the average annual change in the proportion of resections via RATS. Multivariable logistic regressions with interaction terms were used to determine if the change in rates of RATS annually varied by facility type, surrounding population, and location.
Results:
A total of 301,123 oncologic lung resections were included in this study. The number of open resections declined from 16,530 in 2010 to 5,629 in 2021. RATS increased from 733 in 2010 to 10,657 in 2021, while VATS reached a maximum of 10,692 in 2017 and then steadily decreased to 7,434 in 2021. The total number of RATS surpassed VATS in 2019, with 9,579 and 9,454 cases respectively, and RATS accounted for 65.4% of minimally invasive cases by 2021.
Academic programs were found to be increasing the proportion of their RATS resections at a faster rate than community programs. Similarly, facilities in metropolitan settings are adopting robotic resections at a faster rate than in urban and rural areas. Analyses on geographic locations revealed that the rate of RATS adoption varied significantly by region, with the East South-Central region having the slowest adoption rate, whereas the South Atlantic and East North-Central regions had the highest rate of increase in adoption of RATS (Figure 1). Despite these different rates of adoption, RATS lung resections are increasing ubiquitously across institution type, surrounding area, and geographic location.
Conclusions:
RATS for oncologic lung resection is rapidly increasing and surpassed VATS and open resections in 2019. RATS resections are increasing most rapidly in academic and metropolitan programs, and certain geographic regions. Understanding these trends in RATS adoption is essential for optimizing patient care and advancing surgical practice.
Authors
Hayley Reddington (1), Jiddu Guart (1), Zachary Ballinger (1), Rachel Huselid (1), Isabel Cristina Emmerick (1), Allison Crawford (1), Mark Maxfield (1), Karl Uy (1), Feiran Lou (1)
Institutions
(1) UMass Chan Medical School, Department of Surgery, Division of Thoracic Surgery, Worcester, MA