Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand?

Abstract

In the last two decades, robotic-assisted thoracoscopic surgery (RATS) has gained popularity as a minimally invasive surgical (MIS) alternative to multi- and uniportal video-assisted thoracoscopic surgery (VATS). With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception, hand-eye coordination, and freedom of motion of the instruments. Previous studies have shown that a robotic approach for operable lung cancer has treatment outcomes comparable to other MIS techniques such as multi-and uniportal VATS, but with less blood loss, a lower conversion rate to open surgery, better lymph node dissection rates, and improved ergonomics for the surgeon. The thoracic surgeon of the future is expected to perform more complex procedures. More patients will enter a multimodal treatment scheme making surgery more difficult due to severe inflammation. Furthermore, due to lung cancer screening programs, the number of patients presenting with operable smaller lung nodules in the periphery of the lung will increase. This, combined with the fact that segmentectomy is becoming an increasingly popular treatment for small peripheral lung lesions, indicates that the future thoracic surgeons need to have profound knowledge of segmental resections. New imaging techniques will help them to locate these lesions and to achieve a complete oncologic resection. Current robotic techniques exist to help the thoracic surgeon overcome these challenges. In this review, an update of the latest MIS approaches and nodule detection techniques will be given.

Initial experience with robotic technology for thoracic surgery using the da Vinci Xi system in Tibet, China

“…The original intention of robot-assisted surgery was to perform remote surgery on soldiers on the battlefield ( 10 ). Due to the high speed, high reliability, and low latency advantages of 5G networks, the clinical application of robotic surgery has accelerated significantly ( 11 ).…”

Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery

“…Minimally invasive approaches, such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS), have become standard therapies for early-stage lung cancer [ 1 ]. Pulmonary lobectomy and segmentectomy are the two main types of anatomical resections for lung cancer, and segmentectomy has recently been demonstrated to be a valuable alternative to lobectomy [ 2 ]. Anatomical segmentectomy is a more challenging procedure than lobectomy, since the anatomy of pulmonary segments is complex.…”

“…The JCOG0802/WJOG4607L Japanese large-scale randomized trial and the CALGB/Alliance 140503 trial conducted in the United States have shown the potential of sublobar resections for the curative treatment of early-stage non-small cell lung cancer [ 9 , 10 ]. Multiportal VATS, RATS, and uniportal VATS have become more common surgical techniques [ 1 , 2 ], where 3D CT images have been frequently used as surgical guidance for a minimally invasive resection of untouchable and invisible small tumors. Furthermore, various kinds of software have been developed worldwide and marketed mainly for preoperative and intraoperative simulations to reconstruct 3D CT images [ 11 , 12 ].…”