Abstract
A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly.
Highlights
The first day of the Workshop consisted mainly presentations and discussions in the broad areas of future evolution of medical robotics, costs, current situation of robotics in thoracic surgery, and research perspectives in robotic thoracic surgery
While lobectomy remains the standard for stage I non-small cell lung cancer (NSCLC), low-dose CT screening is diagnosing more patients with small early-stage disease, who might be adequately treated by sublobar resection [4], and this is being investigated by ongoing trials [5]
Large proportions of lobectomies in the United States and Europe [27], and increasing proportions of esophagectomies and thymectomies, are being performed using these techniques. This contrasts with the situation in 2008 when a survey of European surgeons found that nearly 60% of responders used video-assisted thoracoscopic surgery (VATS) for lobectomy in less than 5% of cases [32] it would appear that the established advantages of minimally invasive over open surgery – shorter hospital stay, reduced long- and short-term morbidity, and at least equivalent oncological outcomes – are prompting the switch to VATS, notwithstanding its inherent difficulties for the surgeon
Summary
The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and lead to expanded indications.
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