Robotically Assisted Pneumonectomy for Lung Cancer

  • Lorenzo Spaggiari
  • Giulia VeronesiEmail author
  • Ruy Fernando Kuenzer Caetano da Silva


Robotic da Vinci System represents a technological advancement of videothoracoscopic approach and allows to perform advanced and complex pulmonary resection, thanks to the high quality of tridimensional view and precision of instrument movements. It represents a feasible and safe approach for major lung resection for lung cancer, and the technique of robotic lobectomies has been already described by different authors. We describe the indication, surgical technique, and results of four-arm robot-assisted pneumonectomy. Tips and pitfalls are discussed of this new frontier of robotic surgery for lung cancer.


Vinci System Thoracoscopic Lobectomy Oncologic Radicality Utility Incision Seventh Intercostal Space 
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.
    Bettencourt DM, Holmes EC (1988) Muscle-sparing posterolateral thoracotomy. Ann Thorac Surg 45:337–339CrossRefGoogle Scholar
  2. 2.
    Daniel TM, Kern JA, Tribble CG, Kron IL, Spotnitz WB, Rodgers BM (1993) Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations. Ann Surg 217:566–575PubMedCrossRefGoogle Scholar
  3. 3.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW (1993) Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg 56:1248–1253PubMedCrossRefGoogle Scholar
  4. 4.
    Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T (2002) Prospective study of extended segmentectomy for small lung tumors: the final report. Ann Thorac Surg 73:1055–1059PubMedCrossRefGoogle Scholar
  5. 5.
    Koike T, Yamato Y, Yoshiya K, Shimoyama T, Suzuki R (2003) Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg 125:924–928PubMedCrossRefGoogle Scholar
  6. 6.
    McKenna R Jr (1995) Vats lobectomy with mediastinal lymph node sampling or dissection. Chest Surg Clin N Am 5:223–232PubMedGoogle Scholar
  7. 7.
    Yim AP (2002) VATS major pulmonary resection revisited – controversies, techniques, and results. Ann Thorac Surg 74:615–623PubMedCrossRefGoogle Scholar
  8. 8.
    Giudicelli R, Thomas P, Lonjon T, Ragni J, Morati N, Ottomani R, Fuentes PA, Shennib H, Noirclerc M (1994) Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Ann Thorac Surg 58:712–718PubMedCrossRefGoogle Scholar
  9. 9.
    Nomori H, Horio H, Naruke T, Suemasu K (2001) What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery? Ann Thorac Surg 72:879–884PubMedCrossRefGoogle Scholar
  10. 10.
    Yim AP, Wan S, Lee TW, Arifi AA (2000) VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg 70:243–247PubMedCrossRefGoogle Scholar
  11. 11.
    Conlan AA, Sandor A (2003) Total thoracoscopic pneumonectomy: indications and technical considerations. J Thorac Cardiovasc Surg 126:2083PubMedCrossRefGoogle Scholar
  12. 12.
    Craig SR, Walker WS (1995) Initial experience of video assisted thoracoscopic pneumonectomy. Thorax 50:392PubMedCrossRefGoogle Scholar
  13. 13.
    Roviaro G, Varoli F, Vergani C et al (1999) Techniques of pneumonectomy: video-assisted thoracic surgery pneumonectomy. Chest Surg Clin N Am 9:419PubMedGoogle Scholar
  14. 14.
    Roviaro G, Varoli F, Rebuffat C et al (1993) Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg 56:779–783PubMedCrossRefGoogle Scholar
  15. 15.
    Walker WS, Carnochan FM, Mattar S (1994) Video-assisted thoracoscopic pneumonectomy. Br J Surg 81:81–82PubMedCrossRefGoogle Scholar
  16. 16.
    Nwogu CE, Glinianski M, Demmy TL (2006) Minimally invasive pneumonectomy. Ann Thorac Surg 82:e3–e4PubMedCrossRefGoogle Scholar
  17. 17.
    Sahai RK, Nwogu CE, Yendamuri S, Tan W, Wilding GE, Demmy TL (2009) Is thoracoscopic pneumonectomy safe? Ann Thorac Surg 88:1086–1092PubMedCrossRefGoogle Scholar
  18. 18.
    Cerfolio RJ, Bryant AS (2008) Is palpation of the nonresected pulmonary lobe(s) required for patients with non–small cell lung cancer? A prospective study. J Thorac Cardiovasc Surg 135:261–268PubMedCrossRefGoogle Scholar
  19. 19.
    Flores RM, Alam N (2008) Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 85:S710–S715PubMedCrossRefGoogle Scholar
  20. 20.
    Park BJ, Flores RM, Rusch VW (2006) Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg 131:54–59PubMedCrossRefGoogle Scholar
  21. 21.
    Melfi FMA, Mussi A (2008) Robotically assisted lobectomy: learning curve and complications. Thorac Surg Clin 18:289–295PubMedCrossRefGoogle Scholar
  22. 22.
    Gharagozloo F, Margolis M, Tempesta B (2008) Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg 85:1880–1886PubMedCrossRefGoogle Scholar
  23. 23.
    Veronesi G, Galetta D, Maisonneuve P, Melfi F, Schmid RA, Borri A, Vannucci F, Spaggiari L (2010) Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg 140(1):19–25PubMedCrossRefGoogle Scholar
  24. 24.
    Cadiere GB, Himpens J, Vertruyen M, Favretti F (1999) The world’s first obesity surgery performed by a surgeon at a distance. Obes Surg 9:206–209PubMedCrossRefGoogle Scholar
  25. 25.
    Rea F, Marulli G, Bortolotti L, Feltracco P, Zuin A, Sartori F (2006) Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases. Ann Thorac Surg 81:455–459PubMedCrossRefGoogle Scholar
  26. 26.
    Swanson SJ, Herndon JE 2nd, D’Amico TA et al (2007) Video-assisted thoracic surgery lobectomy: report of CALGB 39802 – a prospective, multi-institution feasibility study. J Clin Oncol 25:4993–4997PubMedCrossRefGoogle Scholar
  27. 27.
    Whitson BA, Andrade RS, Boettcher A et al (2007) Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 83:1965–1970PubMedCrossRefGoogle Scholar
  28. 28.
    Walker WS, Codispoti M, Soon SY et al (2003) Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothorac Surg 23:397PubMedCrossRefGoogle Scholar
  29. 29.
    Sugiura H, Morikawa T, Kaji M, Sasamura Y, Kondo S, Katoh H (1999) Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech 9:403–408PubMedGoogle Scholar
  30. 30.
    Shigemura N, Akashi A, Funaki S et al (2006) Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: a multi-institutional study. J Thorac Cardiovasc Surg 132:507–512PubMedCrossRefGoogle Scholar
  31. 31.
    Petersen RP, Pham D, Burfeind WR et al (2007) Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83:1245–1250PubMedCrossRefGoogle Scholar
  32. 32.
    Nicastri DG, Wisnivesky JP, Litle VR et al (2008) Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 135:642–647PubMedCrossRefGoogle Scholar
  33. 33.
    Aoki T, Tsuchida M, Hashimoto T, Saito M, Koike T, Hayashi J (2007) Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy. Heart Lung Circ 16:285–289PubMedCrossRefGoogle Scholar
  34. 34.
    Balduyck B, Hendriks J, Lauwers P, Van Schil P (2007) Quality of life evolution after lung cancer surgery: a prospective study in 100 patients. Lung Cancer 56:423–431PubMedCrossRefGoogle Scholar
  35. 35.
    Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA (2008) 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 86:2008–2018PubMedCrossRefGoogle Scholar
  36. 36.
    Ng CS, Wan IY, Yim AP (2009) Impact of video-assisted thoracoscopic major lung resection on immune function. Asian Cardiovasc Thorac Ann 17:426–432PubMedGoogle Scholar
  37. 37.
    Shiraishi T, Shirakusa T, Hiratsuka M, Yamamoto S, Iwasaki A (2006) Video-assisted thoracoscopic surgery lobectomy for c-T1N0M0 primary lung cancer: its impact on locoregional control. Ann Thorac Surg 82:1021–1026PubMedCrossRefGoogle Scholar
  38. 38.
    Kaseda S, Aoki T, Hangai N, Shimizu K (2000) Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 70:1644–1646PubMedCrossRefGoogle Scholar
  39. 39.
    Sawada S, Komori E, Yamashita M, Nakata M, Nishimura R, Teramoto N et al (2007) Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer. Retrospective analysis focused on a histological subgroup. Surg Endosc 21:1607–1611PubMedCrossRefGoogle Scholar
  40. 40.
    Ng CS, Whelan RL, Lacy AM, Yim AP (2005) Is minimal access surgery for cancer associated with immunologic benefits? World J Surg 29:975–981PubMedCrossRefGoogle Scholar
  41. 41.
    Leaver HA, Craig SR, Yap PL, Walker WS (2000) Lymphocyte responses following open and minimally invasive thoracic surgery. Eur J Clin Invest 30:230–238PubMedCrossRefGoogle Scholar
  42. 42.
    Yamashita JI, Kurusu Y, Fujino N, Saisyoji T, Ogawa M (2000) Detection of circulating tumor cells in patients with non-small cell lung cancer undergoing lobectomy by video-assisted thoracic surgery: a potential hazard for intraoperative hematogenous tumor cell dissemination. J Thorac Cardiovasc Surg 119:899–905PubMedCrossRefGoogle Scholar
  43. 43.
    Nakanishi R, Hirai A, Yamashita T, Oka S (2008) Video-assisted thoracoscopic completion pneumonectomy for a second primary cancer: a case report. J Thorac Cardiovasc Surg 135:945–946PubMedCrossRefGoogle Scholar
  44. 44.
    Suda T, Kitamura Y, Hasegawa S, Negi K, Hattori Y (2007) Video-assisted thoracoscopic extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 134:1088–1089PubMedCrossRefGoogle Scholar
  45. 45.
    Anselmo DM, Perez IA, Shaul DB (2008) Thoracoscopic pneumonectomy for severe bronchiectasis in a 9-year-old female. J Laparoendosc Adv Surg Tech A 18:775–777PubMedCrossRefGoogle Scholar
  46. 46.
    McKenna RJ Jr, Houck W, Beeman Fuller C (2006) Videoassisted thoracic lobectomy: experience with 1100 cases. Ann Thorac Surg 81:421–426PubMedCrossRefGoogle Scholar
  47. 47.
    Kernstine KH (2008) Computer-assisted surgical systems in cardiothoracic surgery: why are we reluctant to accept the future? Ann Thorac Cardiovasc Surg 14:203–204PubMedGoogle Scholar
  48. 48.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L et al (1994) The American European Consensus Conference on ARDS. Definition, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  49. 49.
    Ng T, Ryder BA (2006) Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. J Am Coll Surg 203:551–557PubMedCrossRefGoogle Scholar
  50. 50.
    Ferguson J, Walker W (2006) Developing a VATS lobectomy programme can VATS lobectomy be taught? Eur J Cardiothorac Surg 29:806–809PubMedCrossRefGoogle Scholar
  51. 51.
    Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, Kondo T (2002) A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 73:900–904PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Lorenzo Spaggiari
    • 1
    • 2
    • 3
  • Giulia Veronesi
    • 1
    • 2
    • 3
    Email author
  • Ruy Fernando Kuenzer Caetano da Silva
    • 1
    • 2
    • 3
  1. 1.Division of Thoracic SurgeryEuropean Institute of OncologyMilanItaly
  2. 2.Division of Thoracic SurgeryEuropean Institute of OncologyMilanItaly
  3. 3.Division of Thoracic SurgeryUniversity of Milan School of MedicineMilanItaly

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