Robotics in general thoracic surgery procedures

Abstract

The use of robotic technology in general thoracic surgical practice continues to expand across various institutions and at this point many major common thoracic surgical procedures have been successfully performed by general thoracic surgeons using the robotic technology. These procedures include lung resections, excision of mediastinal masses, esophagectomy and reconstruction for malignant and benign esophageal pathologies. The success of robotic technology can be attributed to highly magnified 3-D visualization, dexterity afforded by 7 degrees of freedom that allow difficult dissections in narrow fields and the ease of reproducibility once the initial set up and instruments become familiar to the surgeon. As the application of robotic technology trickle downs from major academic centers to community hospitals, it becomes imperative that its role, limitations, learning curve and financial impact are understood by the novice robotic surgeon. In this article, we share our experience as it relates to the setup, common pitfalls and long term results for more commonly performed robotic assisted lung and thymic resections using the 4 arm da Vinci Xi robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to help guide those who are interested in adopting this technology. elimination of fulcrum effect with improved dexterity that makes microanastomosis possible in a minimally invasive fashion (8). These advantages are well recognized in thoracic surgical community. In this paper we will describe the utilization of 4 arms da Vinci Xi System for lung and mediastinal mass resection with discussion about patient selection, technique, common pitfalls and useful tips that we have learned from our experience at Memorial Sloan Kettering Cancer Center. Keywords Components of the system and robotic set upThe da Vinci™ Xi Surgical System has three main components; the patient cart, surgeon console and the vision cart (Figure 1). The patient cart comprises the bedside console with the four surgical manipulator arms. In the latest Xi model, the endoscope can be attached to any of the four arms leaving three arms for instrumentation. All four arms including the endoscope are controlled from the surgeon console. This comprises the 3D image viewer, the master hand controls, and the footswitch panel to control electrocautery and allow switching between surgical arms and endoscope control (Figure 2). The endoscope has 30° angulation and a dual camera providing a binocular view of the surgical field to the surgeon console allowing 3D perception.The vision cart contains a touch screen monitor to provide a view of the operative field to the bedside assistants and OR staff. An electrosurgical unit is integrated into the vision cart providing monopolar and bipolar energy to the various da Vinci™ Xi instruments mounted to the patient cart. The cautery is activated via the surgeon console. The robotic instruments and endoscope are interchangeable on the patient cart arms and are inserted into the patient through 8mm trocars....

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