Robot-Assisted Thoracic Surgery and Anesthesia

  • Dirk Smets
  • Bérengère Papegay
  • Laszlo L. SzegediEmail author


Robotic assisted thoracic surgery (RATS) was mainly compared with the video assisted thoracic surgery. This technique gained recognition in thoracic surgery from the 1990s and some articles even reported significant improvements in comparison with open surgery. Nevertheless, a question is rising: is this new technique just a marketing method or it can be really beneficial for the patients and for the physicians, despite its high costs and higher learning curves as compared to more classical techniques? Could machines replace do the physicians job in thoracic surgery? From an anesthetic point of view, are there any differences as compared to other thoracic surgical technic, and if yes, what is the specificity that anesthesiologist should know concerning RATS? This chapter deals with the specificities of RATS, from surgical point of view, through lung separation, ventilation, fluid and pain management, to communication and arrangement of the operating room.


Thoracic Robotic Robot Surgery Anesthesia 


  1. 1.
    Varma TR, Eldridge PR, Forster A, Fox S, Fletcher N, Steiger M, et al. Use of the NeuroMate stereotactic robot in a frameless mode for movement disorder surgery. Stereotact Funct Neurosurg. 2003;80(1-4):132–5.CrossRefGoogle Scholar
  2. 2.
    Nishihara S, Sugano N, Nishii T, Tanaka H, Nakamura N, Yoshikawa H, et al. Clinical accuracy evaluation of femoral canal preparation using the ROBODOC system. J Orthop Sci. 2004;9(5):452–61.CrossRefGoogle Scholar
  3. 3.
    Honl M, Dierk O, Gauck C, Carrero V, Lampe F, Dries S, et al. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. J Bone Joint Surg Am. 2003;85-A(8):1470–8.CrossRefGoogle Scholar
  4. 4.
    Zipper SG, Puschmann H. [Nerve injuries after computer-assisted hip replacement: case series with 29 patients]. Z Orthop Ihre Grenzgeb 2005;143(4):399–402.Google Scholar
  5. 5.
    Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br. 2006;88(2):188–97.CrossRefGoogle Scholar
  6. 6.
    Federspil PA, Geisthoff UW, Henrich D, Plinkert PK. Development of the first force-controlled robot for otoneurosurgery. Laryngoscope. 2003;113(3):465–71.CrossRefGoogle Scholar
  7. 7.
    Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc. 2002;16(10):1389–402.CrossRefGoogle Scholar
  8. 8.
    Melfi FM, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg. 2002;21(5):864–8.CrossRefGoogle Scholar
  9. 9.
    Toker A. Robotic thoracic surgery: from the perspectives of European chest surgeons. J Thorac Dis. 2014;6(Suppl 2):S211–6.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study. Ann Thorac Surg. 1999;68(1):194–200.CrossRefGoogle Scholar
  11. 11.
    Daniels LJ, Balderson SS, Onaitis MW, D’Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg. 2002;74(3):860–4.CrossRefGoogle Scholar
  12. 12.
    McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81(2):421–5; discussion 5–6.CrossRefGoogle Scholar
  13. 13.
    Dylewski MR, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23(1):36–42.CrossRefGoogle Scholar
  14. 14.
    Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001;72(2):362–5.CrossRefGoogle Scholar
  15. 15.
    Veronesi G. Robotic thoracic surgery: technical considerations and learning curve for pulmonary resection. Thorac Surg Clin. 2014;24(2):135–41.CrossRefGoogle Scholar
  16. 16.
    Park BJ. Robotic lobectomy for non-small cell lung cancer: long-term oncologic results. Thorac Surg Clin. 2014;24(2):157–62, vi.CrossRefGoogle Scholar
  17. 17.
    Ghaly G, Kamel M, Nasar A, Paul S, Lee PC, Port JL, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2016;101(2):465–72; discussion 72.CrossRefGoogle Scholar
  18. 18.
    Schwartz GS, Yang SC. Robotic thymectomy for thymic neoplasms. Thorac Surg Clin. 2014;24(2):197–201, vii.CrossRefGoogle Scholar
  19. 19.
    Ismail M, Swierzy M, Ruckert RI, Ruckert JC. Robotic thymectomy for myasthenia gravis. Thorac Surg Clin. 2014;24(2):189–95, vi–vii.CrossRefGoogle Scholar
  20. 20.
    Balduyck B, Hendriks JM, Lauwers P, Mercelis R, Ten Broecke P, Van Schil P. Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection. Eur J Cardiothorac Surg. 2011;39(4):543–8.CrossRefGoogle Scholar
  21. 21.
    Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, et al. Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg. 2010;139(1):53–9 e1.CrossRefGoogle Scholar
  22. 22.
    Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS. Hemodynamic effects of carbon dioxide insufflation during thoracoscopy. Ann Thorac Surg. 1994;58(2):404–7; discussion 7–8.CrossRefGoogle Scholar
  23. 23.
    Campos JH. An update on robotic thoracic surgery and anesthesia. Curr Opin Anaesthesiol. 2010;23(1):1–6.CrossRefGoogle Scholar
  24. 24.
    Campos J, Ueda K. Update on anesthetic complications of robotic thoracic surgery. Minerva Anestesiol. 2014;80(1):83–8.PubMedGoogle Scholar
  25. 25.
    Koopman EM, Barak M, Weber E, Valk MJ, de Schepper RT, Bouwman RA, et al. Evaluation of a new double-lumen endobronchial tube with an integrated camera (VivaSight-DL()): a prospective multicentre observational study. Anaesthesia. 2015;70(8):962–8.CrossRefGoogle Scholar
  26. 26.
    Szarpak L, Kurowski A, Zasko P, Karczewska K, Czyzewski L, Bogdanski L, et al. Double-lumen tube tracheal intubation in a manikin model using the VivaSight Double Lumen: a randomized controlled comparison with the Macintosh laryngoscope. Am J Emerg Med. 2016;34(1):103–4.CrossRefGoogle Scholar
  27. 27.
    Alemzadeh H, Raman J, Leveson N, Kalbarczyk Z, Iyer RK. Adverse events in robotic surgery: a retrospective study of 14 years of FDA data. PLoS One. 2016;11(4):e0151470.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Dirk Smets
    • 1
  • Bérengère Papegay
    • 2
  • Laszlo L. Szegedi
    • 2
    Email author
  1. 1.Department of Thoracic and Oncological Surgery, Universitair Ziekenhuis BrusselVrije Universiteit BrusselBrusselsBelgium
  2. 2.Department of AnesthesiologyBrusselsBelgium

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