Robotics in general thoracic surgery procedures

Abstract

The use of robotic technology in general thoracic surgical practice continues to expand across various institutions and at this point many major common thoracic surgical procedures have been successfully performed by general thoracic surgeons using the robotic technology. These procedures include lung resections, excision of mediastinal masses, esophagectomy and reconstruction for malignant and benign esophageal pathologies. The success of robotic technology can be attributed to highly magnified 3-D visualization, dexterity afforded by 7 degrees of freedom that allow difficult dissections in narrow fields and the ease of reproducibility once the initial set up and instruments become familiar to the surgeon. As the application of robotic technology trickle downs from major academic centers to community hospitals, it becomes imperative that its role, limitations, learning curve and financial impact are understood by the novice robotic surgeon. In this article, we share our experience as it relates to the setup, common pitfalls and long term results for more commonly performed robotic assisted lung and thymic resections using the 4 arm da Vinci Xi robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to help guide those who are interested in adopting this technology.

Keywords: Minimally invasive thoracic surgery; robotic general thoracic surgery; robotic lung surgery; robotic thoracic surgery for novice surgeon.

Figure 1

da Vinci™ Xi patient cart is sterilely draped and ready to be deployed over the patient.

Figure 2

da Vinci™ Xi surgeon’s console.

Figure 3

From left to right, robotic stapler, fenestrated bipolar grasper/dissector, monopolar spatula cautery and tip up fenestrated thoracic grasper that is used for lung retraction.

Figure 4

Typical set up for right-sided lung resection using da Vinci™ Xi system.

Figure 5

Patient positioning and port site marking for right-sided lung resection.

Figure 6

Left upper lobe hilar dissection—part 1 (10). Available online: http://www.asvide.com/articles/1434

Figure 7

Left upper lobe hilar dissection—part 2 (11). Available online: http://www.asvide.com/articles/1435

Figure 8

Use of robotic stapler for division of RUL hilar vessels (12). Available online: http://www.asvide.com/articles/1436

Figure 9

Robotic assisted resection of locally advanced thymoma (13). Available online: http://www.asvide.com/articles/1437