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Review
. 2015 Apr;7(Suppl 2):S122-30.
doi: 10.3978/j.issn.2072-1439.2015.04.34.

Robotic lobectomy and segmentectomy for lung cancer: results and operating technique

Giulia Veronesi  1
Affiliations
Review

Robotic lobectomy and segmentectomy for lung cancer: results and operating technique

Giulia Veronesi. J Thorac Dis. 2015 Apr.

Abstract

Video-assisted thoracic surgery (VATS) is a minimally invasive approach with several advantages over open thoracotomy for the surgery of lung cancer but also some limitations like rigid instruments and suboptimal vision. Robot technology is an evolution of manual videothoracoscopy introduced to overcome these limitations maintaining the advantages related to low invasiveness. More intuitive movements, greater flexibility and high definition three-dimensional vision are advantages of the robotic approach. Different studies demonstrate that robotic lobectomy and segmentectomy are feasible and safe with long term outcome similar to that of open/VATS approaches, however no randomised comparison are available and benefits in terms of quality of life (QOL) and pain need to be demonstrated yet. Several different robotic techniques are currently employed and differ for number of robotic arms (three versus four), the use of CO2 insufflation, timing of utility incision and the port positioning. The four arms robotic approach with anterior utility incision is the technique described by the authors. Indications to perform robotic lung resections may be more extensive than those of traditional videothoracoscpic approach and includes patients with locally advanced disease after chemotherapy or those requiring anatomical segmentectomy. Learning curve of vats and robotic lung resection is similar. High capital and running costs are the most important disadvantages. Entry of competitor companies should drive down costs.

Keywords: Lung cancer; lobectomy; robotics; segmentectomy; surgery.

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Figures

Figure 1
Figure 1
Positions of entry ports for right lobectomy with a utility incision in IV or V intercostals space a camera port in VII or VIII i.c. space and two posterior ports for robotic arms. The arrow indicates the direction of entry of the robot cart. The two blue cycles indicate the incisions used for the anterior videothoracoscopic approach with two ports.
Figure 2
Figure 2
Operating room set-ups for right lung resections.
See this image and copyright information in PMC

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