Robotic thoracic surgery in Brazil

Abstract

Robotic surgery allows for better visualization and better handling of tissues during procedures because of the 3D view and articulated instruments which have more degrees of freedom than our own human wrist. Consequently, it is apparently easier to learn than other modalities of minimally invasive surgery (videoassisted thoracic surgery -VATS) and allows more surgeons to perform more complex procedures, particularly those that require bronchovascular sutures or reconstruction. Contributing for this assumption, recent studies have demonstrated that when compared to VATS, robotic surgery was associated with less frequent conversions, and most of the times, the additional VATS conversions were due to challenging anatomies that could have been more easily managed with the robotic plataform. (1) The first robotic procedures in Brazil were performed in 2008, but the first robotic thoracic robotic procedures were performed in 2010. Since then, we observed a very slow growth of thoracic robotic surgery numbers until 2015 when more platforms arrived, and more thoracic surgeons were trained. (2,3) From, 2015 until 2020 the number of cases performed increased substantially following a greater number of trained surgeons and platforms available. However, from 2021 on, we see a very significant acceleration in the number of thoracic robotic cases performed in Brazil due to several reasons as the increase in the number of platforms, better commercial arrangements, and most importantly the large number of newly trained surgeons since the training process was brought to Brazil and so, the surgeons did not have to go abroad for certification anymore.In 2024, we are aware that there are more than 100 thoracic surgeons that have the minimal documentation to perform robotic surgery and it is estimated that some 1500 to 2000 thoracic robotic procedures have been performed yearly. However, the challenges to start and keep a successful program are huge. The certification process nowadays regulated by the medical societies is very limited and many surgeons are reluctant to start their programs after finishing these short courses, particularly when they are at institutions where