How to get the best from robotic thoracic surgery

Abstract

The application of Robotic technology in thoracic surgery has become widespread in the last decades. Thanks to its advanced features, the robotic system allows to perform a broad range of complex operations safely and in a comfortable way, with valuable advantages related to low invasiveness. Regarding lung tumours, several studies have shown the benefits of robotic surgery including lower blood loss and improved lymph node removal when compared with other minimally invasive techniques. Moreover, the robotic instruments allow to reach deep and narrow spaces permitting safe and precise removal of tumours located in remote areas, such as retrosternal and posterior mediastinal spaces with outstanding postoperative and oncological results. One controversial finding about the application of robotic system is its high capital and running costs. For this reason, a limited number of centres worldwide are able to employ this groundbreaking technology and there are limited possibilities for the trainees to acquire the necessary skills in robotic surgery. Therefore, a training programme based on three steps of learning, associated with a solid surgical background and a consistent operating activity, are required to obtain effective results. Putting this highest technological innovation in the hand of expert surgeons we can assure safe and effective procedures getting the best from robotic thoracic surgery.

Robotic transthoracic diaphragmatic hernia repair

“…Proponents of robotic-assisted surgery cite superior visualization and improved ergonomics; drawbacks include perceived greater cost and longer duration of surgery. 8 The case described here demonstrates that robotic-assisted repair is feasible and may be appropriate in select patients with diaphragmatic hernias, regardless of the size of the hernia. Furthermore, placement of intraabdominal mesh is feasible, and the repair can be reinforced with intrathoracic mesh.…”

Training in robotic thoracic surgery—the European way

“…The proposal for a training program in Europe is largely based on the abovementioned study and touches on similar points as stated by Ricciardi et al (12). Adequate evaluation of the experience after the teaching period is mandatory with bilateral feedback; (VI) Data registration for research, quality surveillance and follow-up; (VII) Next step for value-based health care centered on patients' well-being.…”

Starting experience in robotic thoracic surgery

“…There are articles in the literature, which indicate that robotic surgery training should have 3 phases. Ricciardi et al [1] recommended that a simulator should be used in the first phase. The observation of the interventions implemented by an experienced surgeon, training on animals and cadavers should be considered in the second phase and in the third phase, the candidate should perform robotic surgery starting from simple cases with a dual console if available, if not under the supervision of a proctor.…”

“…The robotic surgery spread rapidly across the world following its introduction in the early 2000s. The implementation of the minimally invasive surgery with high technology got an edge over the open surgery depending on the surgical tools with the maneuver capacity of a human wrist, filtration of the physiological tremor (6-Hz motion filter), good dissection capacity in hard-to-access fields, 3D imaging possibility, and 10x magnification capacity [1]. However, the control of the surgical tools with the joystick on the console (instead of directly next to the patient), the absence of tactual sense and position impingement of the robotic arms are its disadvantages.…”