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Robot-Assisted Thoracoscopic Surgery: Pros and Cons

  • Thoracic Surgery (G. Rocco and M. Scarci, Section Editors)
  • Published:
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Abstract

Purpose of Review

In the last two decades, minimally invasive approaches for thoracic surgery have become the major challenge in the field of thoracic surgery. These techniques became preferable over open surgery (thoracotomy) in terms of reducing pain and having aesthetic advantages. However, patient selection is one of the most important factors for minimally invasive surgery because of related limitations and insufficiency of video-assisted thoracoscopic surgery (VATS).

Recent Findings

Robot-assisted thoracoscopic surgery (RATS) has been developed to overcome the limitations of VATS. Better flexibility and transmission the surgeon’s convenient manoeuvrability in the thoracic cavity are some of the advantages of robotic surgery.

Summary

This paper focuses on the advantages and disadvantages of RATS in comparison to that of VATS and thoracotomy.

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References

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  1. Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, Miyamoto Y. Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg. 2010;89(2):353–9.

    Article  PubMed  Google Scholar 

  2. Cai YX, Fu XN, Xu QZ, Sun W, Zhang N. Thoracoscopic lobectomy versus open lobectomy in stage I non-small cell lung cancer: a meta-analysis. PLoS ONE. 2013;8(12):e82366.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Swanson SJ, Batirel HF. Video-assisted thoracic surgery (VATS) resection for lung cancer. Surg Clin North Am. 2002;82(3):541–59.

    Article  PubMed  Google Scholar 

  4. • Veronesi G. Robotic lobectomy and segmentectomy for lung cancer: results and operating technique. J Thorac Dis. 2015;7(Suppl 2):122–30. There are many educational technical details in this study.

  5. Marulli G, Schiavon M, Perissinotto E, Bugana A, Di Chiara F, Rebusso A, Rea F. Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis. J Thorac Cardiovasc Surg. 2013;145(3):730–5.

    Article  PubMed  Google Scholar 

  6. Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg. 2011;141(3):673–7.

    Article  PubMed  Google Scholar 

  7. Marulli G, Rea F, Melfi F, Schmid TA, Ismail M, Fanucchi O, Augustin F, Swierzy M, Di Chiara F, Mussi A, Rueckert JC. Robot-aided thoracoscopic thymectomy for early-stage thymoma: a Multicenter European study. J Thorac Cardiovasc Surg. 2012;144(5):1125–30.

    Article  PubMed  Google Scholar 

  8. Witte Pfister A, Baste JM, Piton N, Bubenheim M, Melki J, Wurtz A, Peillon C. Thymomectomy by minimally invasive surgery. Comparative study videosurgery versus robot-assisted surgery. Rev Mal Respir. 2017;34(5):544–52.

    Article  CAS  PubMed  Google Scholar 

  9. Kang CH, Hwang Y, Lee HJ, Park IK, Kim YT. Robotic thymectomy in anterior mediastinal mass: propensity score matching study with transsternal thymectomy. Ann Thorac Surg. 2016;102(3):895–901.

    Article  PubMed  Google Scholar 

  10. Profanter C, Schmid T, Prommegger R, Bale R, Sauper T, Bodner J. Robot-assisted mediastinal parathyroidectomy. Surg Endosc. 2004;18(5):868–70.

    Article  CAS  PubMed  Google Scholar 

  11. Kajiwara N, Kakihana M, Usuda J, Ohira T, Kawate N, Ikeda N. Extended indications for robotic surgery for posterior mediastinal tumors. Asian Cardiovasc Thorac Ann. 2012;20(3):308–13.

    Article  PubMed  Google Scholar 

  12. Broussard BL, Wei B, Cerfolio RJ. Robotic surgery for posterior mediastinal pathology. Ann Cardiothorac Surg. 2016;5(1):62–4.

    PubMed  PubMed Central  Google Scholar 

  13. Okusanya OT, Sarkaria IS, Hess NR, Nason KS, Sanchez MV, Levy RM, Pennathur A, Luketich JD. Robotic assisted minimally invasive esophagectomy (RAMIE): the University of Pittsburgh Medical Center initial experiences. Ann Cardiothorac Surg. 2017;6(2):179–85.

    Article  PubMed  PubMed Central  Google Scholar 

  14. van der Sluis PC, Ruurda JP, Verhage RJJ, van der Horst S, Haverkamp L, Siersema PD, Borel Rinkes IHM, ten Kate FJV, van Hillegersberg R. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol. 2015;22:1350–6.

    Article  PubMed Central  Google Scholar 

  15. • 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. doi:10.1016/j.thorsurg.2008.05.003. This study is one of the biggest and earliest study on cost effectivity.

  16. Louie BE, Farivar AS, Aye RW, Vallières E. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg. 2012;93(5):1598–604; discussion 1604–05. doi:10.1016/j.athoracsur.2012.01.067.

    Article  PubMed  Google Scholar 

  17. Park B, 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.

    Article  PubMed  Google Scholar 

  18. • Louie B, Wilson JL, Kim S, Cerfolio RJ, Park BJ, Farivar AS, Vallières E, Aye RW, Burfeind WR Jr, Block MI. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the society of thoracic surgeons database. Ann Thorac Surg. 2016;102:917–24. This study has a big database.

  19. Wilson JL, Louie BE, Cerfolio RJ, Park BJ, Vallières E, Aye RW, Abdel-Razek A, Bryant A, Farivar AS. The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer. Ann Thorac Surg. 2014;97(6):1901–6; discussion 1906–07.

    Article  PubMed  Google Scholar 

  20. •• Toker A, Özyurtkan MO, Demirhan Ö, Ayalp K, Kaba E, Uyumaz E. Lymph node dissection in surgery for lung cancer:comparison of open vs. video-assisted vs. robotic-assisted approaches. Ann Thorac Cardiovasc Surg. 2016;22(5):284–90. This study is new and there are not more study on this issue.

  21. • Swanson SJ, Miller DL, McKenna RJ Jr, Howington J, Marshall MB, Yoo AC, Moore M, Gunnarsson CL, Meyers BF. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg. 2014;147(3):929–37. This study has a big database.

  22. Pardolesi A, Park B, Petrella F, Borri A, Gasparri R, Veronesi G. Robotic anatomic segmentectomy of the lung: technical aspects and initial results. Ann Thorac Surg. 2012;94(3):929–34.

    Article  PubMed  Google Scholar 

  23. Toker A, Ayalp K, Uyumaz E, Kaba E, Demirhan O, Erus S. Robotic lung segmentectomy for malignant and benign lesions. J Thorac Dis. 2014;6(7):937–42.

    PubMed  PubMed Central  Google Scholar 

  24. Demir A, Ayalp K, Ozkan B, Kaba E, Toker A. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg. 2015;20(3):304–9.

    Article  PubMed  Google Scholar 

  25. Mahtabifard A, Fuller CB, McKenna RJ Jr. Video-assisted thoracic surgery sleeve lobectomy: a case series. Ann Thorac Surg. 2008;85(2):S729–32. doi:10.1016/j.athoracsur.2007.12.001.

    Article  PubMed  Google Scholar 

  26. Zhao Y, Jiao W, Ren X, Zhang L, Qiu T, Fu B, Wang L. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system. J Cardiothorac Surg. 2016;11(1):59. doi:10.1186/s13019-016-0453-8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schneiter D, Weder W. Minimal-invasive surgery for lung cancer—strategies and limits. Ther Umsch. 2012;69(7):406–10.

    Article  CAS  PubMed  Google Scholar 

  28. Kwon ST, Zhao L, Reddy RM, Chang AC, Orringer MB, Brummett CM, Lin J. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg. 2017;. doi:10.1016/j.jtcvs.2017.02.008.

    Google Scholar 

  29. Lacroix V, Nezhad ZM, Kahn D, Steyaert A, Poncelet A, Pieters T, Noirhomme P. Pain, quality of life, and clinical outcomes after robotic lobectomy. Thorac Cardiovasc Surg. 2016;65:344–50.

    PubMed  Google Scholar 

  30. Ismail M, Swierzy M, Nachira D, Rückert JC, Gonzalez-Rivas D. Uniportal video-assisted thoracic surgery for major lung resections: pitfalls, tips and tricks. J Thorac Dis. 2017;9(4):885–97. doi:10.21037/jtd.2017.02.04.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yang HJ. Long term survival of early-stage non-small cell lung cancer patients who underwent robotic procedure: a propenity score-matched study. Chin J Cancer. 2016;35:36. doi:10.1097/SLA.0000000000001708.

    Article  Google Scholar 

  32. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, Stiles BM, Port JL, D’Amico TA. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity matched analysis from the STS database. J Thorac CardiovascSurg. 2010;139(2):366–78.

    Article  Google Scholar 

  33. •• Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg. 2011;142(4):740–6. doi:10.1016/j.jtcvs.2011.07.022. There are many educational details in this study.

  34. Jiang G, Yang F, Li X, Liu J, Li J, Zhao H, Li Y, Wang J. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for administration of adjuvant chemotherapy after lobectomy for non-small cell lung cancer. World J Surg Oncol. 2011;21(9):170. doi:10.1186/1477-7819-9-170.

    Article  Google Scholar 

  35. • Nasir BS, Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. Performing robotic lobectomy and segmentectomy: cost, profitability and outcomes. Ann Thorac Surg. 2014;98(1):203–8. doi:10.1016/j.athoracsur.2014.02.051. This study is new, and many different outcomes are investigated.

  36. Deen SA, Wilson JL, Wilshire CL, Vallières E, Farivar AS, Aye RW, Ely RE, Louie BE. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, videoassissted thoracoscopic and robotic approaches. Ann Thorac Surg. 2014;97(3):1000–7. doi:10.1016/j.athoracsur.2013.11.021.

    Article  PubMed  Google Scholar 

  37. Rinieri P, Peillon C, Salaün M, Mahieu J, Bubenheim M, Baste JM. Perioperative outcomes of video- and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann. 2016;24(2):145–51. doi:10.1177/0218492315627556.

    Article  PubMed  Google Scholar 

  38. Augustin F, Bodner J, Maier H, Schwinghammer C, Pichler B, Lucciarini P, Pratschke J, Schmid T. Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting. Langenbecks Arch Surg. 2013;398(6):895–901. doi:10.1007/s00423-013-1090-5.

    Article  PubMed  Google Scholar 

  39. Baste JM, Riviera C, Nouhaud FX, Rinieri P, Melki J, Peillon C. Implementation of a robotic video-assisted thoracoscopic surgical programme. Rev Mal Respir. 2016;33(3):207–17. doi:10.1016/j.rmr.2015.05.004.

    Article  PubMed  Google Scholar 

  40. •• Veronesi G, Galetta D, Maisonneuve P, Melfi F, 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(1):19–25. doi:10.1016/j.jtcvs.2009.10.025. There are many educational details in this manuscript.

  41. •• Fahim C, Hanna W, Waddell T, Shargall Y, Yasufuku K. Robotic-assisted thoracoscopic surgery for lung resection: first Canadian series. Can J Surg. 2017;60(4):5316. doi:10.1503/cjs.005316. This study is new and many educational details in it.

  42. •• Toker A, Özyurtkan MO, Kaba E, Ayalp K, Demirhan Ö, Uyumaz E. Robotic anatomic lung resections: the initial experience and description of learning in 102 cases. Surg Endosc. 2016;30(2):676–83. doi:10.1007/s00464-015-4259-x. There are many educational details in this study.

  43. Toosi K, Velez-Cubian FO, Glover J, Ng EP, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Upstaging and survival after robotic-assisted thoracoscopic lobectomy for non-small cell lung cancer. Surgery. 2016;160(5):1211–8. doi:10.1016/j.surg.2016.08.003.

    Article  PubMed  Google Scholar 

  44. Egberts JH, Schlemminger M, Schafmayer C, Dohrmann P, Becker T. Robot-assisted minimally invasive lobectomy with systematic lymphadenectomy for lung cancer. Zentralbl Chir. 2015;140(1):15–6. doi:10.1055/s-0034-1396253.

    Article  PubMed  Google Scholar 

  45. Mungo B, Hooker CM, Ho JS, Yang SC, Battafarano RJ, Brock MV, Molena D. Robotic versus thoracoscopic resection for lung cancer: early results of a new robotic program. J Laparoendosc Adv Surg Tech A. 2016;26(4):243–8. doi:10.1089/lap.2016.0049.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Liang H, Liang W, Zhao L, Chen D, Zhang J, Zhang Y, Tang S, He J. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg. 2017;. doi:10.1097/SLA.0000000000002346.

    Google Scholar 

  47. Davila HH, Storey RE, Rose MC. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique. J Robot Surg. 2016;10(3):285–8. doi:10.1007/s11701-016-0608-6 (Epub 7 June 2016).

    Article  PubMed  Google Scholar 

  48. Lin MW, Kuo SW, Yang SM, Lee JM. Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer. J Thorac Dis. 2016;8(7):1747–52. doi:10.21037/jtd.2016.06.14.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Thoracic Surgery Department, Istanbul Bilim University, Abide-i Hurriyet Cd, No:166, Sisli, 34381, Istanbul, Turkey

    Tugba Cosgun & Erkan Kaba

  2. Thoracic Surgery Department, Istanbul Florence Nightingale Hospital, Istanbul, Turkey

    Kemal Ayalp, Mezen Rasmi Alomari & Alper Toker

Authors
  1. Tugba Cosgun
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  2. Erkan Kaba
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  3. Kemal Ayalp
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  4. Mezen Rasmi Alomari
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Correspondence to Tugba Cosgun.

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Cosgun, T., Kaba, E., Ayalp, K. et al. Robot-Assisted Thoracoscopic Surgery: Pros and Cons. Curr Surg Rep 5, 27 (2017). https://doi.org/10.1007/s40137-017-0192-3

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