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Objective: To evaluate demographics and quality metrics across racial and ethnic groups amongst patients undergoing lung resection for non-small cell lung cancer (NSCLC) within the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD)., Summary Background: Studies evaluating disparities amongst patients undergoing lung resection for NSCLC are limited., Methods: A retrospective cohort analysis of the STS GTSD was performed between 2015-2022. Multivariable logistic regression was performed for operation (wedge versus anatomic resection), operative approach (open versus minimally invasive), 30-day major morbidity, and combined 30-day morbidity/mortality. Non-Hispanic White patients were the reference group., Results: 103,407 patients underwent resection between 2015-2022. Patients identified as White (88,153; 85.6%), Black (8,924; 8.6%), Asian/PI (4,028; 3.90%), American Indian (274; 0.26%), and Other race (2,028; 1.96%). Black and Hispanic patients were less likely to receive a minimally invasive surgery (MIS) (aOR 0.92 [0.86-0.98], 0.72 [0.70-0.75], respectively). Patients with Medicare (aOR 1.21, 95% CI: 1.08-1.36) or dual Medicare-Medicaid coverage (aOR 1.29, 95% CI: 1.14-1.44) had higher odds of postoperative morbidity, as well as combined morbidity/mortality (Medicare: aOR 1.21, 95% CI: 1.08-1.35; dual coverage: aOR 1.27, 95% CI: 1.13-1.42), compared to those with commercial insurance. These payor types were most prevalent among Black and Hispanic patients., Conclusions: Surgical volumes for racial and ethnic minorities with operable NSCLC remain disproportionately low. Black and Hispanic patients experience disparities in key quality metrics, including lower likelihood of receiving MIS. Payor status was strongly associated with postoperative complications. These findings underscore the need for targeted interventions., Competing Interests: Conflict of interest: Elliot Servais is a consultant for Intuitive Surgical Inc. and Ammara Watkins has received an Intuitive grant for an unrelated project. The other authors have no disclosures., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Understanding characteristics associated with survival after esophagectomy for cancer is critical to preoperative risk stratification. This study sought to define predictors for long-term survival after esophagectomy for cancer in Medicare patients., Methods: The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for patients aged ≥65 years who underwent esophagectomy for cancer between 2012 and 2020 and linked to Centers for Medicare and Medicaid Services (CMS) data using a deterministic matching algorithm. Patient, hospital, and treatment variables were assessed using a multivariable Cox proportional hazards model to evaluate characteristics associated with long-term mortality and readmission. Kaplan-Meier and cumulative incidence curves were generated and differences evaluated using the log-rank test and Gray's test, respectively., Results: After CMS linkage, 4798 patients were included. Thirty-day and 90-day mortality in the study group was 3.84% and 7.45%, respectively. In the multivariable model, American Society of Anesthesiologists score >3, body mass index >35, and diabetes were associated with increased mortality <90 days post-surgery, while pN/pT upstaging was associated with increased mortality >90 days post-surgery. Patients upstaged to pN(+) had a 147% increased mortality risk (adjusted hazard ratio [aHR], 2.47; 95% CI, 2.02-3.02) and those that remained pN(+) a 75% increased mortality risk (aHR, 1.75; 95% CI, 1.57-1.95) compared with downstaged patients. Patients who were pT upstaged had a 109% (aHR, 2.09; 95% CI, 1.73-2.53) increased mortality risk compared with pT downstaged patients. Risk for readmission was independent of procedure type or approach and was higher in c stage ≥2, American Society of Anesthesiologists score ≥4, and pN+., Conclusions: Medicare patients undergoing esophagectomy for cancer have identifiable patient-specific predictors for short-term mortality and tumor-specific predictors for long-term mortality and readmission. In the absence of pathologic T and N downstaging, risk for long-term mortality and readmission are increased., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2025 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: The inability to sense force applied to tissue is suggested as a limitation to robotic-assisted surgery (RAS). This pre-clinical study evaluated the impact of a novel force feedback (FFB) technology, integrated on a next-generation robotic system that allows surgeons to sense forces exerted at the instrument tips, on suturing performance by novice surgeons during RAS., Methods: Twenty-nine novice surgeons (< 50 RAS cases in the last 5 years) were randomized into two groups with (n = 15) or without (n = 14) FFB sensing. Participants performed interrupted stitches on ex vivo porcine bladder and running stitches on porcine aorta (Fig. 1A) over four runs. Average forces applied, number of errors, time for exercise completion, and Robotic Anastomosis Competence Evaluation (RACE) technical skill ratings were compared using a three-way mixed-model ANOVA and applicable post hoc tests. Fig. 1 A View from surgeon console of participant performing suturing tasks using Kotobuki dry model (Exercise 1 to 3), Foam dry model (Exercise 4 and 5), Urinary Bladder ex vivo tissue (Exercise 6), and Aorta ex vivo tissue (Exercise 7). B Description of 7 suturing exercises and anatomical models used for each exercise RESULTS: FFB sensing significantly lowered the mean force applied (bladder, 1.71 N vs 2.40 N, p < 0.006; aorta, 1.80 N vs 2.53 N, p < 0.006), average number of errors (bladder, 0.59 vs 1.76, p < 0.001; aorta, 0.38 vs 1.14, p < 0.001), and the time to completion (bladder, 659 s vs 781 s, p = 0.002; aorta, 460 s vs 570 s, p = 0.001) (Fig. 1C). The FFB group applied less tissue trauma with a higher RACE skill score (3.75 vs 3.03, p = 0.012)., Conclusion: This study showed that novice surgeons using FFB-enabled instruments completed suturing tasks using less force, with fewer errors, taking less time, and less tissue trauma during RAS. Future studies are required to better understand the impact of FFB technology on surgical performance and potential patient benefits., Competing Interests: Declarations. Disclosures: Drs. Andrew J. Hung, Elliot L. Servais, and Laila Rashidi are consultants for Intuitive Surgical. Priyanshi Porwal and Mark Garibaldi are employees of Intuitive Surgical., (© 2024. The Author(s).)

Competing Interests: Disclosures Mara Antonoff reports a relationship with AstraZeneca Pharmaceuticals LP that includes: consulting or advisory; with Merck & Co Inc that includes: consulting or advisory; and with Ethicon Endo-Surgery Inc that includes: consulting or advisory. Leah Backhus reports a relationship with Roche that includes: speaking and lecture fees; with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees; and with Johnson and Johnson SA that includes: speaking and lecture fees. Biniam Kidane reports a relationship with AstraZeneca Pharmaceuticals LP that includes: speaking and lecture fees; with Bristol-Myers Squibb Co that includes: speaking and lecture fees; with Merck & Co Inc that includes: speaking and lecture fees; with Roche that includes: speaking and lecture fees; with Olympus Corporation that includes: consulting or advisory; and with Medtronic that includes: funding grants. Robert A. Meguid reports a relationship with Medtronic that includes: consulting or advisory. Seth Krantz reports a relationship with Medtronic that includes: consulting or advisory; and with Intuitive Surgical Inc that includes: funding grants. Elliot L. Servais reports a relationship with Intuitive Surgical Inc that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Coauthors Mara Antonoff and Brian Mitzman are senior editors for The Annals of Thoracic Surgery, and Kathryn Engelhardt is an associate editor for The Annals of Thoracic Surgery. Leah Backus and David Cooke are Directors-at-Large for The Society of Thoracic Surgeons. The other authors have no conflicts of interest to disclose.

The use of robotic assistance for complex pulmonary resections such as segmentectomy and sleeve lobectomy has steadily increased in recent years. These operations are technically challenging as they require fine dissection and suturing, which is often difficult to perform using traditional minimally invasive techniques. Robotic surgery is well-suited for complex pulmonary surgery given its specific advantages related to superior optics and precise tissue manipulation and dissection. Herein we describe our technique for robotic-assisted complex pulmonary surgery with a specific focus on right upper sleeve lobectomy for cancer, including associated video case demonstration. The principles discussed are generalizable to other complex lung and tracheobronchial operations and highlight the benefits of the robotic platform.