Adoption of the Robotic Platform across Thoracic Surgeries

Abstract

With the paradigm shift in minimally invasive surgery from the video-assisted thoracoscopic platform to the robotic platform, thoracic surgeons are applying the new technology through various commonly practiced thoracic surgeries, striving to improve patient outcomes and reduce morbidity and mortality. This review will discuss the updates in lung resections, lung transplantation, mediastinal surgeries with a focus on thymic resection, rib resection, tracheal resection, tracheobronchoplasty, diaphragm plication, esophagectomy, and paraesophageal hernia repair. The transition from open surgery to video-assisted thoracoscopic surgery (VATS) to now robotic video-assisted thoracic surgery (RVATS) allows complex surgeries to be completed through smaller and smaller incisions with better visualization through high-definition images and finer mobilization, accomplishing what might be unresectable before, permitting shorter hospital stay, minimizing healing time, and encompassing broader surgical candidacy. Moreover, better patient outcomes are not only achieved through what the lead surgeon could carry out during surgeries but also through the training of the next generation via accessible live video feedback and recordings. Though larger volume randomized controlled studies are pending to compare the outcomes of VATS to RVATS surgeries, published studies show non-inferiority data from RVATS performances. With progressive enhancement, such as overcoming the lack of haptic feedback, and future incorporation of artificial intelligence (AI), the robotic platform will likely be a cost-effective route once surgeons overcome the initial learning curve.

Keywords: diaphragm plication; esophagectomy; lung resection; lung transplantation; mediastinal surgery; paraesophageal hernia repair; rib resection; robotic surgery; tracheal resection; tracheobronchoplasty.

Figure 1

Overview of thoracic surgeries that are performed on the robotic platform (Created with BioRender.com).

Figure 2

Robotic lung transplantation incision and port placements [44,45,46]. Key: Red dashed lines represent primary incision, blue dashed circles representat port site incisions, blue Xs represent left atrial clamp incision (Created with BioRender.com).