Robotic thoracic surgery in inflammatory and infective diseases

Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review

Robotic-Assisted Thoracic Surgery (RATS) is considered one of the main issues of present thoracic surgery. RATS is a minimally invasive surgical technique allowing enhanced view, accurate and complex movements, and high ergonomics for the surgeon. Despite these advantages, its application in lung procedures has been limited, mainly by its costs. Since now many different approaches have been proposed and the experience in RATS for lungs ranges from wedge resection to pneumonectomy and is mainly related to lung cancer. The present narrative review explores main approaches and outcomes of RATS lobectomy for lung cancer. A non-systematic review of literature was conducted using the PubMed search engine. An overview of lung robotic surgery is given, and main approaches of robotic lobectomy for lung cancer are exposed. Initial experiences of biportal and uniportal RATS are also described. So far, retrospective analysis reported satisfactory robotic operative outcomes, and comparison with VATS might suggest a more accurate lymphadenectomy. Some Authors might even suggest better perioperative outcomes too. From an oncological standpoint, no definitive prospective study has yet been published but several retrospective analyses report oncological outcomes comparable to those of VATS and open surgery. Literature suggests that RATS for lung procedures is safe and effective and should be considered as a valid additional surgical option.

Two case reports of preoperative selective artery embolization with robotic-assisted thoracoscopic lobectomy for chronic cavitary pulmonary aspergillosis: technology, safety and short-term outcomes

Background

Minimally invasive surgical resection is a possible radical treatment for pulmonary aspergillosis; however, it is difficult and can be accompanied by a variety of complications, especially in chronic cavitary pulmonary aspergillosis (CCPA). Selective artery embolization is usually conducted as palliative management or emergent control of hemoptysis in CCPA. In this report, we share our experience of 2 CCPA patients who underwent preoperative selective artery embolization followed by robotic-assisted thoracoscopic lobectomy.

Case Description

Two male patients with post-tuberculosis CCPA had recurrent hemoptysis. They underwent preoperative selective artery embolization and robotic-assisted thoracoscopic lobectomy in July-August 2022. The intraoperative blood loss volumes for the 2 patients were 160 and 200 mL, respectively. Both patients had good short-term outcomes, and the post-operative stays for each patient were 15 and 9 days, respectively.

Conclusions

Robotic-assisted thoracoscopic lobectomy following selective artery embolization is a potential safe and effective treatment for CCPA. Robotic resection has a number of advantages, including the dexterity, the sharp, 3-dimensional, and magnified vision, and a minimally invasive procedure. Selective preoperative feeding artery embolization can reduce intraoperative bleeding and provide a clearer surgical vision, thus facilitating minimally invasive approaches. We expect further systematic clinical researches to validate the conclusion.

Global status of the robotic thoracic surgery

Robotics has taken its place in thoracic surgery since the end of the 20th century. Since then, it has been developed worldwide with many different applications, such as the treatment of mediastinal tumors and lung cancer. Although, the contradictory results comparing this new technology to other minimally invasive techniques may raise some skepticism, the high quality of the instrument and images provided by the robot brings a whole new perspective for the thoracic surgeon, since the robotic platform can ally the ease of movement obtained with open technique with the advantages of the minimally invasive surgery. When it comes to the implementation of a robotic program the costs of RATS are an important issue. However, it is necessary to take into account not only the cost of the robotic platform itself but also the maintenance expenses, disposable tools, and training programs. Nevertheless, the cost of the robotic surgery is expected to decrease in the coming years and like the instrumentation, virtual reality will see improvements. Many different countries around the world have contributed with original articles for the development of the robotic thoracic surgery and in this paper, we aim at describing the global status of the robotic thoracic surgery.

Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil

OBJECTIVE

in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay.

METHODS

retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020.

RESULTS

a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively.

CONCLUSIONS

robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.