46 - Innovations in Thoracic Surgery

Abstract

The discussion of innovation in thoracic surgery is nearly synonymous with the conversation about robotic surgery. Since first being described in thoracic surgery in the early 2000s, thoracic surgeons have embraced robotic surgery in pulmonary resections, esophageal surgery, mediastinal operations, chest wall, and diaphragm operations. Robotic operations and their complexity continue to advance in the field of thoracic surgery. Furthermore, along with the increasing utilization of lung cancer screening, innovative endobronchial platforms have been developed to improve the sensitivity and accuracy of diagnosis. Prior traditional transbronchial biopsies of nodules had typically yielded poor results, but with the innovation of navigation and the addition of robotic bronchoscopy, the increase of diagnostic yields, sensitivity, and improved safety profile has improved. As we aim to achieve earlier diagnosis of non–small cell lung cancer (NSCLC), surgeons have turned to complex sublobar resections to preserve lung parenchyma. Segmental resections have been aided by the flexibility of the robot as well as near-infrared fluorescent intraoperative imaging. These complex surgeries are aided in part by improved computed tomography (CT) scans with three-dimensional (3D) reconstructions. In addition, 3D printing has aided in further delineating complex thoracic anatomy. These advanced imaging techniques have benefitted surgical planning, education, and prosthetic planning. Lastly, this chapter touches on the options for the treatment of high-risk nonoperative patients with thoracic malignancy; we discuss the current ablative techniques available in the thoracic surgeon’s armamentarium.