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Review
. 2020 Feb;12(2):70-81.
doi: 10.21037/jtd.2020.01.22.

Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections

Michael Mazzei  1 , Abbas E Abbas  1
Affiliations
Review

Why comprehensive adoption of robotic assisted thoracic surgery is ideal for both simple and complex lung resections

Michael Mazzei et al. J Thorac Dis. 2020 Feb.

Abstract

Minimally invasive thoracoscopic surgical techniques have grown increasingly popular due to improved outcome measures compared to conventional rib-spreading thoracotomy. However, video-assisted thoracoscopic surgery (VATS) presents with unique technical challenges that have limited its role in certain cases. Here, we discuss our perspectives on the implementation of a successful robotic thoracic program. We will then present the case for how the adoption of robotic assisted thoracic surgery (RATS) provides the benefits of minimally invasive VATS while still retaining the technical finesse of bimanual articulating instruments and 3-dimensional imaging that is a universal component of any open surgery. We will also discuss how to overcome some of the perceived disadvantages to RATS in regard to the higher cost, lack of tactile feedback and potential safety concerns.

Keywords: Robotic; emergent conversion; lobectomy; portal.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Port placement. All 4 robotic ports in 8th intercostal space. Assistant port in subcostal space, anterior to tip of the 11th floating rib.
Figure 2
Figure 2
Side docking and bedside assistant.
Figure 3
Figure 3
Using the double console. (A) The dual console allows trainees to have the same experience as the primary surgeon; (B) console control allows easy handoff of any or all of the instruments to either of the console surgeons.
Figure 4
Figure 4
Intraoperative electromagnetic navigational bronchoscopic localization (ENBL) for indeterminate lung nodules. (A) Chest CT showing small indeterminate nodule; (B) right upper lobe nodule after ENBL with methylene blue and indocyanine green (ICG); (C) firefly mode clearly demarcates nodule; (D) small sized wedge resection along localization dye.
Figure 5
Figure 5
Using indocyanine green (ICG) pulmonary angiography during anatomical segmentectomy. (A) Normal view of right lower lobe after division of segmental pulmonary arterial branches to superior segment (S6); (B) view with Firefly mode after IV injection of 3 cc ICG clearly demarcates the margin of the non-perfused superior segment (S6).
Figure 6
Figure 6
Benefit of RATS in obese patients. Same patient position and port placement regardless of BMI. (A) Front view; (B) back view; (C) port placement.
See this image and copyright information in PMC

References

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