[Robot-assisted thoracic surgery-Areas of application and limitations]

Short-Term Surgical Outcomes for Lobectomy Between Robot-Assisted Thoracic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery

Objectives

To evaluate the short-term outcomes of uniportal video–assisted thoracoscopic surgery (UVATS) and Da Vinci robot–assisted thoracoscopic surgery (RATS) in lobectomy and lymph node (LN) dissection.

Methods

The two groups of patients with primary non-small cell lung cancer (NSCLC; RATS group, UVATS group) were matched by the propensity score to compare LN dissection and recent clinical outcomes. The results were analyzed by univariate analysis. From November 2020 to November 2021, 412 NSCLC patients (54 RATS and 358 UVATS) from a single institution of the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. Age, sex, lung lobe, surgical resection scope, solid nodules, and core tumor ratios were matched according to different surgical methods.

Results

From November 2020 to November 2021, 412 patients with NSCLC (54 RATS, 358 UVATS) from the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. According to our matching results, LN dissection was more thorough in the RATS group.

Conclusion

RATS has potential advantages over UVATS in radical lung cancer surgery.

[Robotic-assisted Thoracic Surgery]

In the last decade robotic-assisted thoracoscopic surgery (RATS) emerged as a new minimally invasive surgical modality to operate pulmonary, mediastinal and esophageal diseases. Superior to video-assisted thoracoscopic surgery (VATS), RATS affords accurate surgical manipulation in spatially confined anatomical regions. Numerous surgical case studies demonstrated technical reliability and oncological equivalence of RATS compared to open surgery and VATS. Consequently, the number of RATS operations for oncological and non-oncological resections is rising rapidly. The lacking evidence of therapy improvement in the context of significantly increased treatment costs slows the development. Currently, various new companies introduce new robotic surgical platforms into the market and it is expected that market competition will change the costs of these modern therapies. This article summarizes the technical features of RATS and its anesthesiologic implications for patient management.

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery

Purpose of Review

This review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program.

Recent Findings

RATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction in operation theaters caused by the large robotic equipment longs for a reallocation of the anesthetist’s and surgeon’s working environment that may vary additionally depending on the type of surgery performed in the individual patient. Additionally, the implementation of a positive pressure carbon dioxide gas cavity in the pleura has a direct effect on patient cardio-circulatory and respiratory mechanics that have to be balanced by the anesthesiologist.

Summary

RATS advances by replacing open surgery approaches and will complement—but most likely not replace—video-assisted thoracoscopic surgery (VATS). RATS brings new specific intraoperative requirements to the anesthesiological and surgical team members that have to be implemented into clinical routine.

Lung Cancer Surgery after Neoadjuvant Immunotherapy

In early-stage lung cancer, recurrences are observed even after curative resection. Neoadjuvant immunotherapy might be a promising approach to eliminate micrometastasis and to potentially reduce recurrence rates and improve survival. Early trials have shown encouraging rates of pathologic response to neoadjuvant therapy and have demonstrated that surgery can be safely performed after neoadjuvant immunotherapy with various agents and in combination with chemo-(radio)therapy. However, whether these response rates translate into improved disease-free survival rates and overall survival rates remains to be determined by ongoing phase III studies.