Purpose of Review This review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program. Recent Findings RATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction in operation theaters caused by the large robotic equipment longs for a reallocation of the anesthetist’s and surgeon’s working environment that may vary additionally depending on the type of surgery performed in the individual patient. Additionally, the implementation of a positive pressure carbon dioxide gas cavity in the pleura has a direct effect on patient cardio-circulatory and respiratory mechanics that have to be balanced by the anesthesiologist. Summary RATS advances by replacing open surgery approaches and will complement—but most likely not replace—video-assisted thoracoscopic surgery (VATS). RATS brings new specific intraoperative requirements to the anesthesiological and surgical team members that have to be implemented into clinical routine.

Background Various pathologies of the lower ribs may lead to potentially severe pain in a heterogenous group of patients. Costal cartilage excision (CCE) has been shown to result in durable pain relief in some patients. Even though literature is scarce, we reviewed our experience with surgically treated osteo-cartilaginous pain syndromes (OCPSs) of the chest wall. Methods We performed a retrospective case series from two institutions including patients operated for OCPS from 2014 to 2022. Results Our case series consists of 11 patients (72.7% female) with OCPS that were treated by CCE. The median age was 43.5±17.1 years. Body mass index (BMI) was 23.6±3.4 kg/m 2 (range, 18.5–29.6). The interval between first symptoms and diagnosis was 2.6 years (range, 3–127). In 5 patients, symptoms started after preceding chest wall trauma. All but one case were unilateral with no significant predominance regarding the side (6 left/4 right/1 bilateral). Postoperative length of hospital stay was 2.3±0.6 days. There was no patient morbidity or mortality. At follow-up, OCPS related pain had ceased in 7 of 9 patients (78%). Two patients stated to have significantly less pain and two patients didn’t have a follow-up. Conclusions Our analysis indicates that CCE in OCPS is safe and has good long-term results.

Die roboterassistierte Thorakoskopie (RATS) erlaubt dem Chirurgen komplexere Präparationen in der Thoraxhöhle als die videoassistierte Thorakoskopie. Für den Anästhesisten geht sie mit starken Veränderungen seines Arbeitsumfelds einher – und mit direkten Auswirkungen auf die kardiorespiratorische Funktion des Patienten. Dieser Beitrag beleuchtet die Besonderheiten der RATS-Chirurgie für beide Teams und stellt die wichtigsten Indikationen vor.

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