Robotic Surgery in General Thoracic Surgery
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.
KeywordsRobotic Surgery Superior Vena Cava Minimally Invasive Surgery Mediastinal Tumor Azygos Vein
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.
- 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
- 19.Mohr FW (2011) Pioneer in cardiac surgery. Circulation 123:f74Google Scholar
- 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.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.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
- 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
- 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
- 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
- 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.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