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Jiao J, Guo J, Zhao J, Li X, Du M. A universal incision for robot-assisted thoracic surgery. Front Surg 2022; 9:965453. [PMID: 36081586 PMCID: PMC9445219 DOI: 10.3389/fsurg.2022.965453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This paper aimed to design and explore the versatility of the incision for the robot-assisted thoracic surgery. Methods The concept of universal incision was designed and put forward. The clinical data of 342 cases of robot-assisted thoracic surgery were summarized, including sex, age, clinical diagnosis, operative method, operative time, conversion to thoracotomy, intraoperative blood loss, number of lymph node dissections, postoperative hospital stays, postoperative pathology, and postoperative complications of the patients. Results The 342 cases of robot-assisted surgery included 178 pulmonary surgery cases (94 lobectomy cases, 75 segmentectomy cases, 6 wedge resection cases, and 3 sleeve lobectomy cases), 112 esophageal surgery cases (107 McKeown approach cases and 5 esophageal leiomyoma resection cases), and 52 mediastinal tumor cases (42 anterior mediastinum cases and 10 posterior mediastinum cases). Among these, two cases were converted to thoracotomy (both esophageal cases), and the rest were successful with no massive intraoperative bleeding and no perioperative death. Conclusion The universal incision of robot-assisted thoracic surgery is safe and feasible and is suitable for most cases of thoracic surgery.
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Affiliation(s)
- Jia Jiao
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinbao Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Zhao
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangnan Li
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Correspondence: Li Xiangnan Ming Du
| | - Ming Du
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Li Xiangnan Ming Du
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Zhang Y, Chen C, Hu J, Han Y, Huang M, Xiang J, Li H. Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis. J Thorac Cardiovasc Surg 2020; 160:1363-1372. [DOI: 10.1016/j.jtcvs.2019.12.112] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/22/2019] [Accepted: 12/21/2019] [Indexed: 12/23/2022]
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Hu X, Wang M. Efficacy and Safety of Robot-assisted Thoracic Surgery (RATS) Compare with Video-assisted Thoracoscopic Surgery (VATS) for Lung Lobectomy in Patients with Non-small Cell Lung Cancer. Comb Chem High Throughput Screen 2020; 22:169-178. [PMID: 30973106 DOI: 10.2174/1386207322666190411113040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/15/2018] [Accepted: 11/02/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND In the past decade, many researchers focused on Robotic- Assisted Thoracoscopic Surgery (RATS), which has been introduced as an alternative minimally invasive approach, versus Video- Assisted Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small cell lung cancer. However, the advantage of RVATS compared to VATS is still under investigation. The results are unclear. AIM The aim of this study is to compare the efficacy and safety of Robot-assisted Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery (VATS) for lobectomy in patients with Non- Small Cell Lung Cancer (NSCLC). METHODS A systematic electronic search of online electronic databases: Pubmed, Embase, Cochrane library updated in June 2017. The meta-analysis was performed including the studies are designed as randomized or non- randomized controlled. RESULTS Twenty retrospective cohort studies met our inclusion criteria. The pooled analysis of mortality showed that RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 - 0.76; P = 0.0005). With the pooled result of duration of surgery indicated that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI 0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length of hospital stay (MD =0.00, 95% CI -0.03 - 0.03; P = 0.91), number of dissected lymph nodes station (SMD =0.39, 95% CI -0.60 - 1.38; P = 0.44), the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 - 2.56; P = 0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 - 0.73; P = 0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93), arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia (RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR =0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90 - 1.23; P = 0.055) all showed no significant differences between RATS and VATS lobectomy. CONCLUSIONS RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some efforts need to be taken into consideration to reduce the operative time and cost.
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Affiliation(s)
- Xun Hu
- Department of Thoracic Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China
| | - Ming Wang
- Department of Thoracic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China
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Kanzaki M. Current status of robot-assisted thoracoscopic surgery for lung cancer. Surg Today 2019; 49:795-802. [PMID: 30859310 DOI: 10.1007/s00595-019-01793-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/01/2019] [Indexed: 12/24/2022]
Abstract
The robotic surgical system was designed to overcome the drawbacks of conventional endoscopic surgery. Since national health insurance in Japan began covering robotic-assisted thoracoscopic surgery (RATS) for malignant lung and mediastinal tumors in 2018, the number of RATS procedures being performed domestically has increased rapidly. This review evaluates the advantages and disadvantages of RATS for patients with lung cancers, based on an electronic literature search of PubMed. The main advantages of RATS are its ability to achieve excellent lymph-node removal with low morbidity and mortality, and minimal postoperative pain. Conversely, its disadvantages include a long operation time and the need for specialized instruments. However, the learning curve for RATS is reported to be shorter than that for VATS: some studies recommend that a surgeon needs to perform 18-22 robotic operations to attain sufficient skill. RATS for lung cancer is more expensive than VATS and the cost of training is high. Although the main disadvantage of RATS is that it reduces operator's tactile senses, the endoscope, which is directly manipulated by the surgeon at the console, using various magnifications, and 3D HD images on the monitor, may compensate for this. Ultimately, RATS offers better maneuverability, accuracy, and stability over VATS.
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Affiliation(s)
- Masato Kanzaki
- Department of Thoracic Surgery, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Affiliation(s)
- Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Hovgaard LH, Andersen SAW, Konge L, Dalsgaard T, Larsen CR. Validity evidence for procedural competency in virtual reality robotic simulation, establishing a credible pass/fail standard for the vaginal cuff closure procedure. Surg Endosc 2018; 32:4200-4208. [PMID: 29603003 DOI: 10.1007/s00464-018-6165-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of robotic surgery for minimally invasive procedures has increased considerably over the last decade. Robotic surgery has potential advantages compared to laparoscopic surgery but also requires new skills. Using virtual reality (VR) simulation to facilitate the acquisition of these new skills could potentially benefit training of robotic surgical skills and also be a crucial step in developing a robotic surgical training curriculum. The study's objective was to establish validity evidence for a simulation-based test for procedural competency for the vaginal cuff closure procedure that can be used in a future simulation-based, mastery learning training curriculum. METHODS Eleven novice gynaecological surgeons without prior robotic experience and 11 experienced gynaecological robotic surgeons (> 30 robotic procedures) were recruited. After familiarization with the VR simulator, participants completed the module 'Guided Vaginal Cuff Closure' six times. Validity evidence was investigated for 18 preselected simulator metrics. The internal consistency was assessed using Cronbach's alpha and a composite score was calculated based on metrics with significant discriminative ability between the two groups. Finally, a pass/fail standard was established using the contrasting groups' method. RESULTS The experienced surgeons significantly outperformed the novice surgeons on 6 of the 18 metrics. The internal consistency was 0.58 (Cronbach's alpha). The experienced surgeons' mean composite score for all six repetitions were significantly better than the novice surgeons' (76.1 vs. 63.0, respectively, p < 0.001). A pass/fail standard of 75/100 was established. Four novice surgeons passed this standard (false positives) and three experienced surgeons failed (false negatives). CONCLUSION Our study has gathered validity evidence for a simulation-based test for procedural robotic surgical competency in the vaginal cuff closure procedure and established a credible pass/fail standard for future proficiency-based training.
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Affiliation(s)
- Lisette Hvid Hovgaard
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Steven Arild Wuyts Andersen
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Lars Konge
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark
| | - Torur Dalsgaard
- Endometriosis Team and Robotic Surgery Section, Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Christian Rifbjerg Larsen
- Centre for Robotic Surgery, Department of Gynaecology G-115, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev-Gentofte, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Augustin F, Bodner J. Robotic-assisted thoracic surgery: a helpful tool or just another expensive gadget? J Thorac Dis 2017; 9:2881-2883. [PMID: 29220043 DOI: 10.21037/jtd.2017.08.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Johannes Bodner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, StKM, Munich, Germany
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Fahim C, Hanna W, Waddell T, Shargall Y, Yasufuku K. Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series. Can J Surg 2017; 60:260-265. [PMID: 28562237 DOI: 10.1503/cjs.005316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Robotic surgery was introduced as a platform for minimally invasive lung resection in Canada in October 2011. We present the first Canadian series of robotic pulmonary resection for lung cancer. METHODS Prospective databases at 2 institutions were queried for patients who underwent robotic resection for lung cancer between October 2011 and June 2015. To examine the effect of learning curves on patient and process outcomes, data were organized into 3 temporal tertiles, stratified by surgeon. RESULTS A total of 167 consecutive patients were included in the study. Median age was 66 (range 27-88) years, and 46.1% (n = 77) of patients were men. The majority of patients (n = 141, 84%) underwent robotic lobectomy. Median duration of surgery was 270 (interquartile range [IQR] 233-326) minutes, and median length of stay (LOS) was 4 (IQR 3-6) days. Twelve patients (7%) were converted to thoracotomy. Total duration of surgery and console time decreased significantly (p < 0.001) across tertiles, with a steady decline until case 20, followed by a plateau effect. Across tertiles, there was no significant difference in LOS, number of lymph node stations removed, or perioperative complications. CONCLUSION The results of this case series are comparable to those reported in the literature. A prospective study to examine the outcomes and cost of robotic pulmonary resection compared with video-assisted thoracoscopic surgery should be done in the context of the Canadian health care system. We have presented the first consecutive case series of robotic lobectomy in Canada. Outcomes compare favourably to other series in the literature.
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Affiliation(s)
- Christine Fahim
- From McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ont. (Fahim, Hanna); the Department of Surgery, McMaster University, Hamilton, Ont. (Hanna, Shargall); and the Department of Surgery, University of Toronto, Toronto, Ont. (Waddell, Yasufuku)
| | - Waël Hanna
- From McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ont. (Fahim, Hanna); the Department of Surgery, McMaster University, Hamilton, Ont. (Hanna, Shargall); and the Department of Surgery, University of Toronto, Toronto, Ont. (Waddell, Yasufuku)
| | - Thomas Waddell
- From McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ont. (Fahim, Hanna); the Department of Surgery, McMaster University, Hamilton, Ont. (Hanna, Shargall); and the Department of Surgery, University of Toronto, Toronto, Ont. (Waddell, Yasufuku)
| | - Yaron Shargall
- From McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ont. (Fahim, Hanna); the Department of Surgery, McMaster University, Hamilton, Ont. (Hanna, Shargall); and the Department of Surgery, University of Toronto, Toronto, Ont. (Waddell, Yasufuku)
| | - Kazuhiro Yasufuku
- From McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ont. (Fahim, Hanna); the Department of Surgery, McMaster University, Hamilton, Ont. (Hanna, Shargall); and the Department of Surgery, University of Toronto, Toronto, Ont. (Waddell, Yasufuku)
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
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Agzarian J, Fahim C, Shargall Y, Yasufuku K, Waddell TK, Hanna WC. The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review. Semin Thorac Cardiovasc Surg 2016; 28:182-92. [DOI: 10.1053/j.semtcvs.2016.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 11/11/2022]
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Anatomic Lung Segmentectomy: Literature Review and Update of Experience with Robot-Assisted Procedures. CURRENT SURGERY REPORTS 2015. [DOI: 10.1007/s40137-015-0088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kumar A, Asaf BB. Robotic thoracic surgery: The state of the art. J Minim Access Surg 2015; 11:60-7. [PMID: 25598601 PMCID: PMC4290121 DOI: 10.4103/0972-9941.147693] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 12/20/2022] Open
Abstract
Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Liu M, Curet M. A review of training research and virtual reality simulators for the da Vinci surgical system. TEACHING AND LEARNING IN MEDICINE 2015; 27:12-26. [PMID: 25584468 DOI: 10.1080/10401334.2014.979181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. APPROACH This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. FINDINGS An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.
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Affiliation(s)
- May Liu
- a Medical Research Department , Intuitive Surgical, Inc. , Sunnyvale , California , USA
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Nakamura H, Suda T, Ikeda N, Okada M, Date H, Oda M, Iwasaki A. Initial results of robot-assisted thoracoscopic surgery in Japan. Gen Thorac Cardiovasc Surg 2014; 62:720-5. [PMID: 25467061 DOI: 10.1007/s11748-014-0441-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES As surgical robots have become increasingly used, verification of their usefulness in the general thoracic surgery field is required. Initial results of robot-assisted thoracoscopic surgery in Japan were investigated. METHODS A questionnaire survey was performed to retrospectively examine the current status of robotic surgery for general thoracic disease in Japan. The subjects were 112 cases performed by the end of September 2012 at 9 institutions. RESULTS There were 60 cases of primary lung cancer, 38 cases of anterior-middle mediastinal disease, and 14 cases of posterior mediastinal disease. In lung cancer cases, the operative time was 284.7 min, the blood loss was 129 mL, the drainage period was 3.3 days, and the conversion rate was 3.3 %. The incidence of postoperative complications was 6.7 %. The postoperative hospital stay was 8.2 days. In cases of anterior-middle mediastinal disease, the operative time was 184.3 min, the blood loss was 43.8 mL, the drainage period was 2.3 days, and there was no conversion. The incidence of postoperative complications was 7.9 %. The postoperative hospital stay was 7.1 days. In cases of posterior mediastinal disease, the operative time was 142.6 min, the blood loss was 61.4 mL, the drainage period was 1.6 days, and there was no conversion. No postoperative complication developed in any case. The postoperative hospital stay was 5 days. In all cases underwent robotic surgery, there was no operation related mortality. CONCLUSIONS Robotic surgery was safely introduced, and the incidence of postoperative complications tended to be low, although the operative time was long. Preparations for its employment in advanced medical care and coverage by national health insurance are urgent issue.
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Affiliation(s)
- Hiroshige Nakamura
- Research Committee of Robotic Surgery for General Thoracic Disease, Japanese Association for Chest Surgery, Kyoto, Japan,
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Abstract
Anatomic lung segmentectomy is a possible alternative to lobectomy for small (<2 cm) primary lung cancers. Interest in anatomic lung segmentectomy has increased further after the adoption of high-resolution computed tomography and the implementation of lung cancer screening studies, which are increasing the detection rate of small lung cancers. Robotic surgery seems well suited to the precise dissection required for anatomic segmentectomy. Initial experience of robotic anatomic segmentectomy in patients with a single primary or metastatic lung lesion is highly encouraging. The introduction of robotic staplers, aspirators, and 5-mm lung forceps will further increase precision.
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Affiliation(s)
- Alessandro Pardolesi
- Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy.
| | - Giulia Veronesi
- Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy
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Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg 2014; 20:93-8. [PMID: 24583699 DOI: 10.5761/atcs.ra.13-00314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The safety and efficacy of thoracoscopic and robot-assisted lobectomies for primary lung cancer were reviewed in the literature. Thoracoscopic surgery is less invasive compared to thoracotomy, and it has been reported to be superior with regard to the outcome. In addition, the operability of a surgical robot (da Vinci) is favorable and supplements the disadvantages of conventional endoscopic surgery. Robot-assisted lobectomy has been reported to be comparable to thoracoscopic surgery with regard to the safety and efficacy based on analysis of perioperative results and superior with regard to the operability and length of the learning curve. However, a high cost and a long operative time are of concern. Since robot-assisted surgery has been performed only in early cases, the continuation of a comparative investigation may be necessary.
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Affiliation(s)
- Hiroshige Nakamura
- Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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