Complete Port-Access Robotic-Assisted Lobectomy Utilizing Three-Arm Technique Without a Transthoracic Utility Incision

  • Mark R. Dylewski
  • Richard Lazzaro
  • Abbas E. Abbas


Despite the superior outcomes of VATS compared to thoracotomy, review of STS database substantiates limited adoption of VATS. Therefore, VATS cannot be acknowledged as the “standard of care” for the treatment of pulmonary malignancies. During the past decade, robotic surgical systems have been increasingly utilized to perform highly complex surgical procedures. The use of the robot in thoracic surgery is in its early development; however, the trend in robotic-assisted thoracic surgery is projected to surpass the adoption of VATS and to mirror that of other robotic surgical subspecialties. This chapter outlines a robotic video-assisted thoracoscopic technique for lung resection that has been proven safe and feasible and more importantly could encourage broader use of minimally invasive lobectomy for a broader population of patients with clinically operable lung cancer.


Pulmonary Resection Vinci Surgical System Hilar Structure Systematic Lymph Node Dissection Assistant Port 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ginsburg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac Surg. 1995;60:615–23.CrossRefGoogle Scholar
  2. 2.
    Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. J Thorac Cardiovasc Surg. 1993;106:1111–7.PubMedGoogle Scholar
  3. 3.
    Kirby TJ, Rice TW. Thoracoscopic lobectomy. Ann Thorac Surg. 1993;56:784–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Lewis RJ. The role of video-assisted thoracic surgery for cancer of the lung: wedge to lobectomy by simultaneous stapling. Ann Thorac Surg. 1993;56:762–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Swanson SJ, Herndon J, D’Amico TA, et al. Results of CALGB 39802 feasibility of VATS lobectomy for lung cancer. Proc Am Soc Clin Oncol. 2002;21:290a.Google Scholar
  6. 6.
    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;74:860–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Whitson BA, Andrade RS, et al. Video-assisted thoracoscopic surgery is a more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007;83:1965–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Mack MJ, Scruggs GR, Kelly KM, Shennib H, Landreneau RJ. Video-assisted thoracic surgery: has technology found it place? Ann Thorac Surg. 1997;64:211–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Iwasaki M, Kaga K, Nishiumi N, et al. Experience with the two-windows method for mediastinal lymph node dissection in lung cancer. Ann Thorac Surg. 1998;65:800–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg. 1993;56:1248–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Melfi FM, Menconi GF, Marianin AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg. 2002;21:864–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Park JB, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg. 2006;131:54–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Gharagozloo F, Margolis M, Tempesta B. Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg. 2008;85:1880–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Dylewski MD, Ohaeto AC, Pereira JF. Pulmonary resection using a total endoscopic robotic-assisted approach. Semin Thorac Cardiovasc Surg. 2011;23(1):36–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Gharagozloo F, Margolis M, Tempesta B, et al. Robotic-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg. 2009;88:330–84.CrossRefGoogle Scholar
  16. 16.
    Park BJ, Flores RM. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin. 2008;18(3):297–300. vii.CrossRefPubMedGoogle Scholar
  17. 17.
    Veronesi G, Galetta D, Maisonneuve P, Melfi DF, Schmid RA, Borri A, Vannucci F, Spaggiari L. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg. 2010;140:19–25.CrossRefPubMedGoogle Scholar
  18. 18.
    Park BJ, Melfi F, Mussi A, Maisonneuve P, Spaggiari L, Da Silva RK, Veronesi G. Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg. 2012;143(2):383–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86:2008–18.CrossRefPubMedGoogle Scholar
  20. 20.
    McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1100 cases. Ann Thorac Surg. 2006;81:421–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure. Ann Surg. 2006;244(3):420–5.PubMedGoogle Scholar
  22. 22.
    Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS. Published date August 9, 2006. Accessed 31 Mar 2003Google Scholar
  23. 23.
    Takagi H, et al. Perioperative results of robotic lung lobectomy: summary of the literature. Surg Endosc. 2012;26(12):3697–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Cao C, Manganas C, Ang SC, Yan TD. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg. 2012;1(1):3–10.PubMedGoogle Scholar
  25. 25.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Lobectomy—video-assisted thoracic surgery verses muscle-sparing thoracotomy. A randomized trial. J Thoracic Cardiovasc Surg. 1995;109(5):997–1001.CrossRefGoogle Scholar
  26. 26.
    Shiraishi T, Shirakusa T, Miyoshi T, Hiratsuka M, Yamamoto S, Iwasaki A. A completely thoracoscopic lobectomy/segmentectomy for primary lung cancer: technique, feasibility and advantages. Thorac cardiovasc Surg. 2006;54:202–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Gossot D. Technical tricks to facilitate totally endoscopic major pulmonary resection. Ann Thorac Surg. 2008;86:323–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Lewis RJ, Caccavale RJ, Sisler GE, Bocage JP, Mackenzie JW. VATS simultaneously stapled lobectomy. Ann Thorac Surg. 1997;64:1869–71.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mark R. Dylewski
    • 1
  • Richard Lazzaro
    • 2
  • Abbas E. Abbas
    • 3
  1. 1.Department of Cardiac Vascular and Thoracic SurgeryBaptist Health of South FloridaMiamiUSA
  2. 2.North Shore LIJ Health System, Lenox Hill HospitalNew YorkUSA
  3. 3.Department of SurgeryOchsner Clinic FoundationNew OrleansUSA

Personalised recommendations