Safety and Oncologic Outcomes of Robotic Lobectomy in the Early Adoption Phase: First Single-Surgeon Experience from the Polish Healthcare System.

BACKGROUND

Robotic-assisted thoracic surgery is increasingly recognized as an advanced minimally invasive technique for treating non-small cell lung cancer, offering technical advantages such as enhanced precision and visualization. Although numerous studies have been published worldwide, there are no comparable data from Poland. Therefore, evidence on the perioperative safety and oncologic adequacy of robotic-assisted lobectomy during early phase of program implementation within the Polish healthcare system remains limited.

METHODS

This retrospective, single-institution observational study included 81 consecutive patients who underwent robotic-assisted lobectomy for primary NSCLC between January 2022 and December 2024. All procedures were carried out using the da Vinci Xi system with a standardized four-arm portal approach. Clinical, perioperative, and pathologic parameters were prospectively collected and analyzed descriptively. Postoperative complications were classified according to Clavien-Dindo.

RESULTS

The median patient age was 70 years (IQR: 65-74), 52% were male, and 67% had a history of smoking. Adenocarcinoma was the predominant histologic subtype (51%). The median operative time was 176 min (IQR: 149-220). There were no conversions to thoracotomy and no 30-day mortalities. Postoperative complications occurred in 24% of cases, with prolonged air leak being most common (17%). The median hospital stay was 8 days (IQR: 6-10). R0 resection was achieved in 96% of patients, with a median of 14 lymph nodes dissected across 5 nodal stations.

CONCLUSIONS

Robotic-assisted lobectomy performed during the early implementation phase of a national program demonstrated low morbidity, high rates of complete (R0) resection, and adequate lymph node yields consistent with international benchmarks. These results support the feasibility of robotic lobectomy within the Polish healthcare setting; however, the single-surgeon, single-center design limits generalizability. Further multicenter prospective studies are needed to confirm reproducibility, assess learning curves, and evaluate long-term oncologic outcomes.