Robotic anatomic lung resections: the initial experience and description of learning in 102 cases Alper Toker 1 • Mehmet Og˘uzhan O ¨ zyurtkan 1 • Erkan Kaba 1 • Kemal Ayalp 1 • O ¨ zkan Demirhan 1 • Elena Uyumaz 1 Received: 11 February 2015 / Accepted: 13 May 2015 Ó Springer Science+Business Media New York 2015 Abstract Background The aim of this study was to analyze our initial pulmonary resection experience with robotic surgery (Da Vinci, Intuitive Surgical, Inc., Mountain View, California, USA) and define the learning curve based on the duration of operations. Methods A retrospective review was conducted on patients undergoing robotic pulmonary resections from October 2011 to December 2014. The operating time, including the dock- ing and console times, postoperative hospitalization, and peri- and postoperative complications were studied. Results Hundred patients underwent 102 robotic ana- tomic pulmonary resections due to various pathologies. Fifty-three percent of the patients underwent lobectomy procedure, whereas 45 % underwent segmentectomy. The mean operating time was 104 ± 34 min. The learning curve was calculated to be 14 patients (R 2 = 0.57). The complication rate in our series was 24 % (n = 24) and higher in elderly patients (p = 0.03) and in patients with longer operating times (p = 0.03). Prolonged air leaks were observed in 10, and arrhythmia developed in nine patients. Two patients died, due to a concurrent lym- phoblastic leukemia diagnosed at the postoperative period and exacerbation of interstitial fibrosis, respectively. Conclusions Robotic pulmonary resections prove to be safe and effective even at the initial learning experience. The duration of operations is considered to be acceptable. The learning curve could be established after 14 cases. Keywords Learning curve Á Pulmonary surgical procedure Á Robotic surgical procedures Á Treatment outcome The introduction of minimally invasive approaches in the early 1990s proved to be a major advance in thoracic surgery. Video-assisted thoracoscopic surgery (VATS) has gained wide acceptance as both diagnostic and therapeutic procedures despite its limited two-dimensional vision, un- steady camera platform, and limited maneuverability of the instruments [1]. More recently, the arrival of robotic sur- gery has led to the further refinement of the concept and practice of minimally invasive surgery. The use of the surgical robot has widely spread worldwide as it provides a high-resolution binocular view, three-dimensional imaging, no fulcrum effect, filtration of physiological tremor, ‘‘wrist-like’’ action of the instruments, and capability of fine dissections in confined spaces [2]. Today, several authors have performed robotic thoracic surgery with encouraging results [3–13]. As an academic thoracic surgery center, we have been performing minimally invasive anatomic lung resections with VATS for 8 years. We adopted the da Vinci Robotic System (Intuitive Surgical, Inc., Mountain View, California, USA) on October 2011. Our preliminary results on robotic thoracic surgery have been published [14, 15]. Here we report our experience with robotic thoracic pulmonary resections so far, define the learning period, and compare our results with the literature. Materials and methods A retrospective review was conducted on patients undergoing robotic pulmonary resections from October 2011 to Decem- ber 2014. All patients had chest computed tomography with & Mehmet Og˘uzhan O ¨ zyurtkan moozyurtkan@hotmail.com 1 Department of Thoracic Surgery, Istanbul Bilim University and Group Florence Nightingale Hospital, Abide-i Hu¨rriyet Cad. No: 166, S¸ is¸li, Istanbul, Turkey 123 Surg Endosc DOI 10.1007/s00464-015-4259-x and Other Interventional Techniques