Transition from video-assisted thoracic surgery to robotic pulmonary surgery

Abstract

The "da Vinci Surgical System" is a robotic surgical system that utilizes multi-jointed robotic arms and a high-resolution three-dimensional video-monitoring system. We report on the state of transition from video-assisted thoracoscopic surgery (VATS) to robotic pulmonary surgery, the surgical outcomes of robotic surgery compared to VATS, and the future of robotic surgery. Surgery utilizing the da Vinci Surgical System requires a console surgeon and assistant who have been certified by Intuitive Surgical, Inc., the system manufacturer. On the basis of the available medical literature, a robotic lobectomy has a learning curve that extends over approximately 20 cases for a surgeon who has mastered VATS. Surgery using the da Vinci System is safe, is associated with lower morbidity and mortality rates than thoracotomy, leads to shorter postoperative hospital stays, and ensures improved postoperative quality of life. Currently, no prospective studies comparing it to VATS have been conducted. The various studies that have compared robotic surgery and VATS have reported different results. At the present time, the benefits to patients of robotic surgery compared to VATS remain unclear. Areas in which robotic surgery may be superior to VATS include the superior operability of robotic surgery that improves safety and decreases the incidence of complication. To show that the costly robotic surgery is superior to VATS, prospective multicenter randomized studies need to be conducted. The da Vinci robot-assisted surgical system has already been highly evaluated for its safety, with recent studies reporting satisfactory outcomes. It remains necessary to verify whether the benefits to patients justify the higher cost of robotic surgery. Future developments in the field of robotic engineering will likely lead to the creation of systems that are even less invasive and allow for more advanced surgical techniques.

Keywords: Robot; lung; minimally invasive surgery; robotics; thoracoscopy/VATS.

Figure 1

Placement of the da Vinci port for left lung cancer surgery. (A) A port held in the surgeon’s left hand is inserted above the fifth intercostal anterior axillary line; (B) a 3-cm skin incision is made above the sixth intercostal medial axillary line, and a GelPOINT Mini (Applied Medical, Rancho Santa Margarita, CA, USA) is affixed for the camera scope and manipulations by the surgical assistant; (C,D) ports are inserted by the surgeon’s right hand above the seventh intercostal posterior axillary line and more dorsally than the posterior axillary line of the seventh intercostal space. The two ports must be spaced at a minimum of 6 cm apart.

Figure 2

Placement of instruments during left lung surgery using the da Vinci Xi Surgical System. As the da Vinci surgical cart is docked to the side of the patient, the anesthesiologist can manage sedation from the patient’s head without interfering with the da Vinci instruments.

Figure 3

Left upper lobectomy using da Vinci Xi System (2). Available online: http://www.asvide.com/articles/1456