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Robotic Surgery in General Thoracic Surgery

  • Hyun-Sung Lee
  • Hee-Jin Jang
Chapter

Abstract

Robotic assistance can facilitate minimally invasive surgery (MIS) and has been widely adopted across multiple specialties. This article reviews the published literature on the use of this technology for the treatment of thoracic diseases and describes the robot-assisted thoracoscopic techniques for lung cancer and mediastinal tumors. Although the most common use for robotics has been to treat urologic oncologic conditions, it has also widely started to be adopted for general thoracic surgeries. For early-stage lung cancer treatment, there is evidence that robotics offers short-term benefits, such as shorter lengths of stay (LOS) and decreased postoperative pain, with safety profiles and oncologic outcomes comparable with open or thoracoscopic approaches. However, long-term oncologic outcomes are generally lacking, and robotic surgeries are more costly than open or thoracoscopic surgeries. Therefore, whether the benefits of robotics justify the higher costs warrant large comparative effectiveness studies with long-term outcomes.

Keywords

Robotic Surgery Superior Vena Cava Minimally Invasive Surgery Mediastinal Tumor Azygos Vein 
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.

Notes

Acknowledgments

I would like to send a great thanks to my mentor, Dr. Jae Ill Zo for always being in my corner with great support. And, I appreciate all my patients and colleagues for my robotic surgeries.

References

  1. 1.
    Kwoh YS, Hou J, Jonckheere EA, Hayati S (1988) A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Bio Med Eng 35(2):153–160. doi: 10.1109/10.1354 CrossRefGoogle Scholar
  2. 2.
    Satava RM (2002) Surgical robotics: the early chronicles—a personal historical perspective. Surg Laparosc Endosc Percutan Tech 12(1):6–16PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson CA, Hellan M, Falebella A, Lau CS, Grannis FW, Kernstine KH (2007) Robotic-assisted lung resection for malignant disease. Innovations 2(5):254–258. doi: 10.1097/IMI.0b013e31815e52f1 PubMedGoogle Scholar
  4. 4.
    Ashton RC Jr, Connery CP, Swistel DG, DeRose JJ Jr (2003) Robot-assisted lobectomy. J Thorac Cardiovasc Surg 126(1):292–293PubMedCrossRefGoogle Scholar
  5. 5.
    Augustin F, Bodner J, Wykypiel H, Schwinghammer C, Schmid T (2011) Initial experience with robotic lung lobectomy: report of two different approaches. Surg Endosc 25(1):108–113. doi: 10.1007/s00464-010-1138-3 PubMedCrossRefGoogle Scholar
  6. 6.
    Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experiences with the da Vinci™ operating robot in thoracic surgery. Eur J Cardiothorac Surg 25(5):844–851. doi: 10.1016/j.ejcts.2004.02.001 PubMedCrossRefGoogle Scholar
  7. 7.
    Braumann C, Jacobi CA, Menenakos C, Ismail M, Rueckert JC, Mueller JM (2008) Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech 18(3):260–266. doi: 10.1097/SLE.0b013e31816f85e5 PubMedCrossRefGoogle Scholar
  8. 8.
    Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ (2011) Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg 142(4):740–746. doi: 10.1016/j.jtcvs.2011.07.022 PubMedCrossRefGoogle Scholar
  9. 9.
    Dylewski MR, Ohaeto AC, Pereira JF (2011) Pulmonary resection using a total endoscopic robotic video-assisted approach. Semin Thorac Cardiovasc Surg 23(1):36–42. doi: 10.1053/j.semtcvs.2011.01.005 PubMedCrossRefGoogle Scholar
  10. 10.
    Gharagozloo F, Margolis M, Tempesta B (2008) Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann Thorac Surg 85(6):1880–1885. doi: 10.1016/j.athoracsur.2008.02.085, Discussion 1885-1886PubMedCrossRefGoogle Scholar
  11. 11.
    Gharagozloo F, Margolis M, Tempesta B, Strother E, Najam F (2009) Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg 88(2):380–384. doi: 10.1016/j.athoracsur.2009.04.039 PubMedCrossRefGoogle Scholar
  12. 12.
    Giulianotti PC, Buchs NC, Caravaglios G, Bianco FM (2010) Robot-assisted lung resection: outcomes and technical details. Interact Cardiovasc Thorac Surg 11(4):388–392. doi: 10.1510/icvts.2010.239541 PubMedCrossRefGoogle Scholar
  13. 13.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784. doi: 10.1001/archsurg.138.7.777 PubMedCrossRefGoogle Scholar
  14. 14.
    Jang HJ, Lee HS, Park SY, Zo JI (2011) Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: a single-institution case series matching study. Innovations 6(5):305–310. doi: 10.1097/IMI.0b013e3182378b4c PubMedGoogle Scholar
  15. 15.
    Kernstine KH, Anderson CA, Falabella A (2008) Robotic lobectomy. Oper Tech Thorac Cardiovasc Surg 13(3):204.e1–204.e23CrossRefGoogle Scholar
  16. 16.
    Melfi FM, Menconi GF, Mariani AM, Angeletti CA (2002) Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 21(5):864–868PubMedCrossRefGoogle Scholar
  17. 17.
    Park BJ, Flores RM, Rusch VW (2006) Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg 131(1):54–59. doi: 10.1016/j.jtcvs.2005.07.031 PubMedCrossRefGoogle Scholar
  18. 18.
    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):19–25. doi: 10.1016/j.jtcvs.2009.10.025 PubMedCrossRefGoogle Scholar
  19. 19.
    Mohr FW (2011) Pioneer in cardiac surgery. Circulation 123:f74Google Scholar
  20. 20.
    Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung cancer study group. Ann Thorac Surg 60(3):615–622, Discussion 622–613PubMedCrossRefGoogle Scholar
  21. 21.
    Swanson SJ, Herndon JE II, D'Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ (2007) Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol 25(31):4993–4997PubMedCrossRefGoogle Scholar
  22. 22.
    Rueth NM, Andrade RS (2010) Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg 89:S2107–2111. doi: 10.1016/j.athoracsur.2010.03.020 PubMedCrossRefGoogle Scholar
  23. 23.
    Farjah F, Wood DE, Mulligan MS, Krishnadasan B, Heagerty PJ, Symons RG, Flum DR (2009) Safety and efficacy of video-assisted versus conventional lung resection for lung cancer. J Thorac Cardiovasc Surg 137(6):1415–1421. doi: 10.1016/j.jtcvs.2008.11.035 PubMedCrossRefGoogle Scholar
  24. 24.
    Flores RM, Alam N (2008) Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 85(2):S710–715. doi: 10.1016/j.athoracsur.2007.09.055 PubMedCrossRefGoogle Scholar
  25. 25.
    Grogan EL, Jones DR (2008) VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes? Thorac Surg Clin 18(3):249–258. doi: 10.1016/j.thorsurg.2008.04.007 PubMedCrossRefGoogle Scholar
  26. 26.
    Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole DH Jr, D'Amico TA (2007) Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83(4):1245–1249. doi: 10.1016/j.athoracsur.2006.12.029, Discussion 1250PubMedCrossRefGoogle Scholar
  27. 27.
    Whitson BA, D'Cunha J, Andrade RS, Kelly RF, Groth SS, Wu B, Miller JS, Kratzke RA, Maddaus MA (2008) Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg 86(6):1735–1744. doi: 10.1016/j.athoracsur.2008.07.001 PubMedCrossRefGoogle Scholar
  28. 28.
    Yan TD, Black D, Bannon PG, McCaughan BC (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27(15):2553–2562. doi: 10.1200/JCO.2008.18.2733 PubMedCrossRefGoogle Scholar
  29. 29.
    Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD (2008) Data from the society of thoracic surgeons general thoracic surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 135(2):247–254. doi: 10.1016/j.jtcvs.2007.07.060 PubMedCrossRefGoogle Scholar
  30. 30.
    Cao C, Manganas C, Ang SC, Yan TD (2012) A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg 1(1):3–10. doi: 10.3978/j.issn.2225-319X.2012.04.03 PubMedCentralPubMedGoogle Scholar
  31. 31.
    Lee HS, Jang HJ (2012) Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg 24(2):131–141. doi: 10.1053/j.semtcvs.2012.02.004 PubMedCrossRefGoogle Scholar
  32. 32.
    Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, Jones DR, McKenna RJ, Landreneau RJ, Rusch VW (2011) Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American college of surgery oncology group Z0030 trial. J Thorac Cardiovasc Surg 141(3):662–670. doi: 10.1016/j.jtcvs.2010.11.008 PubMedCrossRefGoogle Scholar
  33. 33.
    Izbicki J, Thetter O, Habekost M, Karg O, Passlick B, Kubuschok B, Busch C, Haeussinger K, Knoefel W, Pantel K (2005) Radical systematic mediastinal lymphadenectomy in non‐small cell lung cancer: a randomized controlled trial. Br J Surg 81(2):229–235CrossRefGoogle Scholar
  34. 34.
    Keller SM, Adak S, Wagner H, Johnson DH (2000) Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern cooperative oncology group. Ann Thorac Surg 70(2):358–365, Discussion 365–356PubMedCrossRefGoogle Scholar
  35. 35.
    Park JS, Kim K, Choi MS, Chang SW, Han WS (2011) Video-assisted thoracic surgery (VATS) lobectomy for pathologic stage I non-small cell lung cancer: a comparative study with thoracotomy lobectomy. Korean J Thorac Cardiovasc Surg 44(1):32–38. doi: 10.5090/kjtcs.2011.44.1.32 PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    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(3):900–904PubMedCrossRefGoogle Scholar
  37. 37.
    Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, Sato H, Abe T (2005) Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 138(3):510–517PubMedCrossRefGoogle Scholar
  38. 38.
    Park BJ, Melfi F, Mussi A, Maisonneuve P, Spaggiari L, Da Silva RK, Veronesi G (2012) Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg 143(2):383–389. doi: 10.1016/j.jtcvs.2011.10.055 PubMedCrossRefGoogle Scholar
  39. 39.
    Park BJ (2012) Robotic lobectomy for non-small cell lung cancer (NSCLC): multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg 1(1):24–26. doi: 10.3978/j.issn2225-319X.2012.04 PubMedCentralPubMedGoogle Scholar
  40. 40.
    Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L, International Association for the Study of Lung Cancer International Staging C, Participating I (2007) The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol: Official Publication of the International Association for the Study of Lung Cancer 2(8):706–714. doi: 10.1097/JTO.0b013e31812f3c1a CrossRefGoogle Scholar
  41. 41.
    Toker A, Sonett J, Zielinski M, Rea F, Tomulescu V, Detterbeck FC (2011) Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol 6(7 Suppl 3):S1739–1742. doi: 10.1097/JTO.0b013e31821ea553 PubMedCrossRefGoogle Scholar
  42. 42.
    Marulli G, Rea F, Melfi F, Schmid TA, Ismail M, Fanucchi O, Augustin F, Swierzy M, Di Chiara F, Mussi A, Rueckert JC (2012) Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg 144(5):1125–1130. doi: 10.1016/j.jtcvs.2012.07.082 PubMedCrossRefGoogle Scholar
  43. 43.
    Toker A, Erus S, Ozkan B, Ziyade S, Tanju S (2011) Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis? Interact Cardiovasc Thorac Surg 12(2):152–155. doi: 10.1510/icvts.2010.254599, Epub 2010 Nov 9PubMedCrossRefGoogle Scholar
  44. 44.
    McKenna RJ Jr (2008) Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 18(3):275–280. doi: 10.1016/j.thorsurg.2008.04.004 PubMedCrossRefGoogle Scholar
  45. 45.
    Park BJ, Flores RM (2008) Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin 18(3):297–300. doi: 10.1016/j.thorsurg.2008.05.003, viiPubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Department of Systems Biology, Division of Cancer MedicineUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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