2022 World Conference on Lung Cancer (ePosters)-EP02.03-008. Combined Robotic Assisted Thoracic Surgery (CRATS)

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A retrospective review of Combined Robotic Assisted Thoracic Surgery (CRATS) cases at Medstar Georgetown University Hospital was presented. CRATS combines the use of Ion robotic bronchoscopy, endobronchial ultrasound (EBUS), and the DaVinci robot for a single anesthesia procedure to diagnose, stage, and resect suspicious lung nodules. The study included operable patients with small lung nodules (0.7cm - 3.0cm) who had no enlarged mediastinal lymph nodes on PET/CT scan. The patients underwent Ion robot bronchoscopy with transbronchial needle aspiration (TBNA), brushing, and transbronchial biopsies (TBBX) of the nodules. Indocarmine green (ICG) dye was inserted into the nodules for localization using a TBNA needle, and EBUS TBNA was performed for mediastinal staging. Once the lymph nodes were confirmed to be normal, the patients underwent resection of the nodules.<br /><br />A total of 13 CRATS cases were performed during the study period. Eleven cases involved Ion robot bronchoscopy-guided TBNA, brush, and TBBX, along with EBUS TBNA and ICG dye marking. Two cases included ICG dye marking alone followed by resection. All cases underwent a single anesthesia procedure with robotic resection (2 segmentectomies and 11 lobectomies). Intraoperative pathology review of EBUS TBNA lymph nodes confirmed normal lymph nodes in all patients. Ion-guided lung nodule biopsies were diagnostic in 9 out of 11 patients. The final pathology results included 7 cases of stage IA non-small cell lung cancer (NSCLC), 1 stage IIB (T3N0) typical carcinoid, 1 stage IIB (T3N0) NSCLC, 1 hamartoma, and 1 benign granuloma. CRATS was the definitive treatment for 12 out of 13 patients, while the patient with stage IIB NSCLC was recommended to undergo adjuvant chemotherapy.<br /><br />Overall, CRATS appears to be a promising approach for the diagnosis, staging, and treatment of suspicious lung nodules. It allows for accurate biopsy, dye marking, and resection of smaller peripheral nodules, potentially shortening the time from initial CT imaging to definitive diagnosis, staging, and treatment.

Asset Subtitle

Eric Dolven Anderson

Meta Tag

Speaker Eric Dolven Anderson

Topic Early Stage Non-small Cell Lung Cancer - Surgery

Keywords

CRATS

Medstar Georgetown University Hospital

Ion robotic bronchoscopy

endobronchial ultrasound

EBUS

DaVinci robot

lung nodules

diagnosis

staging

resection