Current status of robot-assisted thoracoscopic surgery in Japan

Abstract

Since approximately 2000, when surgical robotic systems were first introduced, robot-assisted thoracoscopic surgery (RATS) has been adopted by dozens of major institutes, particularly in the United States and several European countries. In Japan, video-assisted thoracoscopic surgery (VATS), especially multiport VATS, was developed and standardized in various facilities during this period. In April 2018, RATS lobectomy and resection of mediastinal tumors were started to be covered by national health insurance. In Japan, the number of RATS procedures has increased rapidly in recent days, and it is expected to become more common and familiar to Japanese thoracic surgeons of all generations. The da Vinci Surgical System has several well-known clear technical advantages, such as a three-dimensional visual field that can be magnified up to 10 times, articulated joint forceps with seven degrees of freedom, and a motionscaling function that prevents camera and instrument shaking. These advantages provide thoracic surgeons with higher-quality instrument maneuverability and general comfort during surgery. While there are many technical advantages in RATS, there are also many non-technical skills that thoracic surgeons should be aware of, such as risk management of intraoperative bleeding. In this review article, we outline the current status of RATS for lung cancer and mediastinal tumor excision in Japan and discuss various issues and the future perspectives of robotic surgery.