Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 28;15(2):909-917.
doi: 10.21037/jtd-22-818. Epub 2022 Nov 15.

Prolonged air leak after robotic lung resection: a narrative review

Piergiorgio Muriana  1 , Francesca Rossetti  1 , Stefano Viscardi  1 , Pierluigi Novellis  1 , Giulia Veronesi  1   2
Affiliations
Review

Prolonged air leak after robotic lung resection: a narrative review

Piergiorgio Muriana et al. J Thorac Dis. .

Abstract

Background and objective: Prolonged air leak (PAL) following lung resection is related to an increase in morbidity and both direct and indirect costs. In recent years, robotic-assisted thoracic surgery (RATS) has proved to be a safe technique with comparable perioperative outcomes of video-assisted thoracic surgery (VATS), optimal oncological results, and potential advantages in case of sublobar resection. We here focus on the incidence and clinical impact of PAL in the field of robotic surgery and discuss the therapeutic strategies currently available.

Methods: We conducted a search on PubMed/MEDLINE and Scopus database from inception until May 27th 2022 to select the relevant literature published in English exploring the occurrence of PAL following RATS.

Key content and findings: The implementation of robotic surgery led to a significant reduction in PAL occurrence after pulmonary resection compared to open thoracotomy, while there is still no clear advantage with respect to VATS. However, the enhanced dexterity and improved visualization of the robot seem to particularly valuable in case of sublobar lung resection, especially complex ones. Accurate selection of patients based on the presence of risk factors allows the implementation of intraoperative measures in order to reduce the occurrence of PAL.

Conclusions: Robotic lung resection is a safe technique, advantageous compared to traditional open thoracotomy in terms of PAL occurrence reduction and it is a valid alternative to manual VATS. Moreover, with the extension of indications for sublobar resection in the treatment of early stage lung cancer, RATS may prove to be the technique of choice thanks to its intrinsic advantages.

Keywords: Air leak; lobectomy; management; robotic surgery; segmentectomy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-818/coif). The special series “Prolonged Air Leak after Lung Surgery: Prediction, Prevention and Management” was sponsored by Bard Limited. Bard Limited has no interference on the contents of the special series. GV received grants from Umberto Veronesi Foundation, Intuitive Surgical Inc., AIRC, Italian Ministry of Health and Inail. GV is a consultant for Ab Medica SpA, Medtronic and Johnson & Johnson. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
PAL risk-stratification scoring systems (16,17). ESTS, European Society of Thoracic Surgeons; STS, the Society of Thoracic Surgeons; PAL, prolonged air leak; FEV1, forced expiratory volume in one second; BMI, body mass index.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 2002;21:864-8. 10.1016/s1010-7940(02)00102-1 - DOI - PubMed
    1. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg 2010;140:19-25. 10.1016/j.jtcvs.2009.10.025 - DOI - PubMed
    1. Oh DS, Reddy RM, Gorrepati ML, et al. Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data. Ann Thorac Surg 2017;104:1733-40. 10.1016/j.athoracsur.2017.06.020 - DOI - PubMed
    1. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg 2019;28:526-34. 10.1093/icvts/ivy315 - DOI - PubMed
    1. Novellis P, Maisonneuve P, Dieci E, et al. Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer. J Clin Med 2021;10:1687. 10.3390/jcm10081687 - DOI - PMC - PubMed