Four-arm robotic lobectomy for the treatment of early-stage lung cancer

Abstract

Robotic lobectomy with lymph node dissection is practicable, safe, and associated with shorter postoperative hospitalization than open surgery. From the number of lymph nodes removed it also appears oncologically acceptable for early lung cancer. Benefits in terms of postoperative pain, respiratory function, and quality of life still require evaluation. We expect that technologic developments will further simplify the robotic procedure.

Robotic Surgery for Thoracic Disease

“…5) Veronesi et al and Cerfolio et al revealed no significant differences between robotic and open lobectomy in terms of morbidity and mortality. 5,22) Furthermore, other groups reported similar morbidity and mortality rates between robotic and VATS lobectomy. 9,17,23) However, they showed shorter hospital stays after robotic lobectomy than open lobectomy.…”

“…9,[15][16][17] Cerfolio et al reported a four-arm technique without a utility incision, while Veronesi et al included the incision. 5,8) Carbon dioxide (CO 2 ) insufflation to achieve maximal surgical exposure while compressing the lung away from the operative area may provide the benefit for thoracoscopic surgery. 18) Cerfolio et al named completely portal robotic lobectomy (CPRL) by using CO 2 insufflation.…”

“…Both VATS and robotic surgery are minimally invasive, but several differences have been reported. 5) It seems that VATS has drawbacks including less hand-eye coordination under the two-dimensional imaging system, limited manipulation of instruments, and steep learning curves. In contrast, robotic surgery has several advantages such as natural movement of the surgeon's hands when manipulating the robotic arms and instruments controlled by computerassisted systems.…”

Robotic lung resections: video-assisted thoracic surgery based approach

“…Briefly, the specific robotic techniques utilized are as follows: completely portal four arm technique (1); a completely portal three-arm technique with 5 cm extraction incision (7); and a three-or four-arm technique with a 3 cm to 4 cm non-rib spreading utility incision (3). VATS based approach is consistent with the 3-4 arm technique with a non-rib spreading utility incision.…”

“…Robotics enabled rapid adoption in minimally invasive approaches for pelvic, cardiac and colorectal surgery, where vision and maneuverability are limited with open and laparoscopic approaches. In the past 10 years, robotic surgery has been adopted by thoracic surgeons unequivocally, and proved to have at least similar or better outcomes compared to VATS or open surgery, in terms of lower rate of complications, less blood loss, shorter hospital stay, less pain, and faster return to normal quality of life (1)(2)(3)(4). Fast learning curve, provided by high definition three-dimensional camera, enhanced surgical maneuverability and precise surgery, has developed robotic lung surgery in the past 5 years.…”