Future Development and Technologies

  • Zheng Li
  • Calvin S. H. NgEmail author


Since its introduction in the beginning of this millennium, uniportal VATS has received great interests. Despite its advantages over conventional operations, uniportal VATS poses great challenges to the surgeon. This is mainly as a consequence of inserting and operating all the instruments via a small incision. In the uniportal VATS instruments have limited movement and instrument fencing is frequent with some haptic sensation loss. In addition, the vision is restricted as the endoscope is nearly parallel to the instruments. The advancement of technology has or will much alleviate these shortcomings. For example, wide-angled thoracoscope and flexible thoracoscope have to some extent lessen the fencing problem, and the wireless steerable endoscope system may further eliminate the instrument-endoscope fencing and provide panoramic view. New uniportal platforms derived from natural orifice transluminal endoscopic surgery (NOTES) and single-port access surgery approaches are on the horizon, which allows the uniportal VATS to be performed in a much easier way and via even smaller incisions. However, problems associated with provision of a steady platform, sufficient payload and applied force, tool change and equipment sterilization, haptic sensation, etc. remain to be solved. The diagnosis and intraoperative localization of small tumors can be challenging especially in uniportal VATS. Advanced multimodality image-guided operating room (AMIGO) and hybrid operating room can help in real-time diagnosis, localization and reduce the associated problems in patient transferring.


  1. 1.
    Nesher N, Galili R, Sharony R, et al. Videothorascopic sympathectomy (VATS) for palmar hyperhidriosis: summary of a clinical trial and surgical results [J]. Harefuah. 2000;138(11):913.PubMedGoogle Scholar
  2. 2.
    Ng CSH, Lau KKW, Gonzalez-Rivas D, Rocco G. Evolution in surgical approach & techniques for lung cancer. Thorax. 2013;68:681.CrossRefGoogle Scholar
  3. 3.
    EndoCAMeleon® Hopkins® Telescope (visited on 2016, July 20), Available
  4. 4.
    Ng CSH, Wong RHL, Lau RWH, Yim APC. Single port video-assisted thoracic surgery: advancing scope technology. Eur J Cardiothorac Surg. 2015;47(4):751.CrossRefGoogle Scholar
  5. 5.
    Endoeye by Olympus (visited on 2015, October 24), Available
  6. 6.
    Li Z, Oo MZ, Nalam V, et al. Design of a novel flexible endoscope—cardioscope [J]. J Mech Robot. 2016;8(5):051014.CrossRefGoogle Scholar
  7. 7.
    Ng CSH, Wong RHL, Lau RWH, Yim APC. Minimizing chest wall trauma in single port video-assisted thoracic surgery. J Thorac Cardiovasc Surg. 2014;147(3):1095–6.CrossRefGoogle Scholar
  8. 8.
    Park S, Bergs RA, Eberhart R, et al. Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor [J]. Ann Surg. 2007;245(3):379–84.CrossRefGoogle Scholar
  9. 9.
    Cadeddu J, Fernandez R, Desai M, et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience [J]. Surg Endosc. 2009;23(8):1894–9.CrossRefGoogle Scholar
  10. 10.
    Ng CSH, Rocco G, Wong RHL, Lau RWH, Yu SCH, Yim APC. Uniportal and single incision video assisted thoracic surgery – the state of the art. Interact Cardiovasc Thorac Surg. 2014;19(4):661–6.CrossRefGoogle Scholar
  11. 11.
    Li Z, Ng CSH. Future of uniportal video-assisted thoracoscopic surgery—emerging technology [J]. Ann Cardiothorac Surg. 2016;5(2):127.CrossRefGoogle Scholar
  12. 12.
    Zhao ZR, Li Z, Situ DR, et al. Recent clinical innovations in thoracic surgery in Hong Kong [J]. J Thorac Dis. 2016;8(Suppl 8):S618–26.CrossRefGoogle Scholar
  13. 13.
    Ren HL, Lim CM, Wang J, Liu W, Song S, Li Z, Herbert G, Tse ZTH, Tan Z. Computer assisted transoral surgery with flexible robotics and navigation technologies: a review of recent progress and research challenges. Crit Rev Biomed Eng. 2013;4:365–91.CrossRefGoogle Scholar
  14. 14.
    Vitiello V, Lee SL, Cundy TP, Yang GZ. Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng. 2013;6:111–26.CrossRefGoogle Scholar
  15. 15.
    Bardou B, Nageotte F, Zanne P, de Mathelin M. Design of a telemanipulated system for transluminal surgery. In: Proceedings of the 31st annual international conference of the IEEE engineering in medicine and biology society. Minneapolis, MN, 2009. pp. 5577–5582.Google Scholar
  16. 16.
    Dallemagne B, Marescaux J. The ANUBISTM project. Minim Invasive Ther Allied Technol. 2010;19:257–61.CrossRefGoogle Scholar
  17. 17.
    Spaun G, Zheng B, Swanström L. A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc. 2009;23:2720–7.CrossRefGoogle Scholar
  18. 18.
    Phee SJ, Kencana AP, Huynh VA, Sun ZL, Low SC, Yang K, Lomanto D, Ho KY. Design of a master and slave transluminal endoscopic robot for natural orifice transluminal endoscopic surgery. Proc Inst Mech Eng C J Mech Eng Sci. 2010;224:1495–503.CrossRefGoogle Scholar
  19. 19.
    The Flex Robotic System by Medrobotics (visited on 2015, October 24), Available
  20. 20.
    Lau KC, Leung EYY, Chiu PWY, et al. A flexible surgical robotic system for removal of early-stage gastrointestinal cancers by endoscopic submucosal dissection [J]. IEEE Trans Ind Inf. 2016;99:1–11.Google Scholar
  21. 21.
    Torora G, Dario P, Menciassi A. Array of robots augmenting the kinematics of endocavitary surgery. IEEE/ASME Trans Mechatron. 2014;19(6):1821–9.CrossRefGoogle Scholar
  22. 22.
    Da Vinci Single Port Robot (visited on 2018, August 10), Available
  23. 23.
    The SPORTTM Surgical System by Titan Medical Inc. (visited on 2015, October 24), Available
  24. 24.
  25. 25.
    Xu K, Zhao JG, Fu MX. Development of the SJTU unfoldable robotic system (SURS) for single port laparoscopy. IEEE/ASME Trans Mechatron. 2015;20(5):2133–45.CrossRefGoogle Scholar
  26. 26.
    Li Z, Du R. Expanding workspace of underactuated flexible manipulator by actively deploying constrains. In: Proceedings of IEEE international conference on robotics and automation (ICRA 2014). Hong Kong, China, IEEE.Google Scholar
  27. 27.
    Li Z, Feiling J, Ren HL, Yu HY. A novel tele-operated flexible robot targeted for minimally invasive surgery. Engineering. 2015;1(1):73–8.CrossRefGoogle Scholar
  28. 28.
    Gill RR, Zheng Y, Barlow JS, et al. Image-guided video assisted thoracoscopic surgery (iVATS)-phase I-II clinical trial [J]. J Surg Oncol. 2015;112(1):18–25.CrossRefGoogle Scholar
  29. 29.
    Ng CSH, Chu CM, Kwok MWT, et al. Hybrid DynaCT scan-guided localization single-port lobectomy [J]. Chest J. 2015;147(3):e76–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SARChina
  2. 2.Chow Yuk Ho Technology Centre for Innovative MedicineThe Chinese University of Hong KongHong Kong SARChina
  3. 3.Division of Cardiothoracic Surgery, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong KongHong Kong SARChina

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