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Review
. 2017 Jun 4:3:78.
doi: 10.21037/jovs.2017.04.03. eCollection 2017.

Robotic assisted lobectomy for locally advanced lung cancer

Giulia Veronesi  1 , Pierluigi Novellis  1 , Orazio Difrancesco  2 , Mark Dylewski  3
Affiliations
Review

Robotic assisted lobectomy for locally advanced lung cancer

Giulia Veronesi et al. J Vis Surg. .

Abstract

Some series report the use of video-assisted thoracic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) but, few studies describe the use of the robotic approach specifically for locally advanced disease. One potential advantage of the robotic approach over traditional VATS is the increased radicality. While the benefit of the robotic approach over open thoracotomy is directly related to reduced surgical trauma and the improved tolerability in fragile patients that have received induction treatment. In case of occult N2 disease, robotic assisted surgery can translate into a quicker recovery with improved compliance with adjuvant treatments following surgery. Technical details are reported and described. The robotic instrument technology allows sharp and controlled dissection compared to the typical blunt sweeping methods used in most VATS lobectomy techniques. The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumors. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs, reduced operating room efficiencies, and a steep learning curve.

Keywords: Lung cancer; locally advanced; multimodality treatment; robotic surgery.

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Conflict of interest statement

Conflicts of Interest: G Veronesi is a consultant for ABI Medica SpA and Medtronic. M Dylewski is a clinical educator for Intuitive Surgical and he has received honoraria by Verb Medical, Ethicon and Barb Corp. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient position.
Figure 2
Figure 2
Robotic ports and utility incision.
Figure 3
Figure 3
Lymph node dissection of station 7th from the right side.
Figure 4
Figure 4
Radical lymph node dissection of subcarinal station form right side (28). Available online: http://www.asvide.com/articles/1543
Figure 5
Figure 5
Radical lymph node dissection of station R2–R4 (29). Available online: http://www.asvide.com/articles/1544
Figure 6
Figure 6
Station 5th and station 6th lymph nodes dissection (left side).
Figure 7
Figure 7
Right lower lobectomy after chemotherapy for N2 paraesophageal lymph node (30). Available online: http://www.asvide.com/articles/1545
Figure 8
Figure 8
Left lower lobectomy plus posterior segment of left upper lobe (31). Available online: http://www.asvide.com/articles/1546
Figure 9
Figure 9
Right upper sleeve lobectomy after chemotherapy for N2 disease (32). Available online: http://www.asvide.com/articles/1547
See this image and copyright information in PMC

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