Robotic pulmonary lobectomy—The future and probably should remain so

Abstract

Listen

Translate article

Using robotic technology to perform pulmonary surgery is of great current interest to the thoracic surgical community. With the advent of video-assisted thoracic surgery in the early 1990s, we have provided major benefit to our patients undergoing all types of surgical procedures from videoassisted thoracoscopic surgery (VATS) pleural biopsy to what is now becoming more routine, VATS lobectomy. No question exists that increasing data have shown that perioperative recovery, complication rates, quality of life, and cost to the system all favor a VATS approach over an open approach (thoracotomy) for pulmonary lobectomy. For the most important outcome variable, that of cancer-related survival, the data have continued to suggest at least an equivalence between VATS lobectomy and thoracotomy and lobectomy, with a hint of improved survival using the VATS approach. In the Society of Thoracic Surgeons database, VATS lobectomy has increased to more than 30% of all lobectomies performed. This operation is now quite standardized, with an approach to the hilar vessels, bronchus, and lymph nodes similar to that of the open approach. Training programs have incorporated this operation into the standard armamentarium of the thoracic resident, and simulations courses and fellowships are available to help provide learning opportunities to surgeons who are out in practice. With this background, robotic lobectomies have been performed on a limited basis, with the advocates suggesting that the visualization and dissection are superior compared with a VATS approach. Robotic technology does have a certain appeal. The arms have a wrist-like movement and the magnification and depth of field of the robotic camera are superior to the standard VATS camera. However, it is not clear that these are significant advantages compared with VATS in the realm of cancer surgery. They might be useful for cardiac or urologic procedures; however, in thoracic arena, where the field is wide and the operation is primarily one