Robotic Surgery for Lung Cancer

Abstract

Lung cancer is the leading cause of cancer related deaths in developed countries. Although the best strategy for reducing lung cancer mortality is tobacco cessation, patients harboring lung cancer need specific treatment. Surgical treatment is the best choice for localized early tumors, without local or distant malignant spread. Pulmonary lobectomy can be performed by open thoracotomy or by minimally invasive techniques as video-assisted thoracic (VATS) or robotic assisted surgery. VATS lobectomy is a safe, efficient, well accepted and widespread technique among thoracic surgeons, but standard VATS forceps have rigid extremities and do not mimics wrist angulated movements. Furthermore, traditional VATS video-imaging is a simple two dimensional image. Robotic surgery is performed with telemanipulated flexible effector instruments; some of them can give surgeons tactile feedback; and under three-dimensional (3-D) video-imaging. Hilar pulmonary dissection for lung cancer can be performed by robotic devices in an efficient and safe way. Scientifically speaking, oncological results need further studies including longer postoperative follow-up to allow comparisons between VATS and robotic techniques; but similarities between these approaches regarding the extension of resected structures as pulmonary parenchyma and lymph nodes suggest that robotic surgery is going to be proved as efficient as VATS for lung cancer. Learning curve can be one of the biases when comparing results between traditional or VATS lobectomy to robotic surgery. Costs have been implied as one of the major difficulties in becoming robotic lobectomy more used among thoracic surgeons, but some authors have already studied this issue and concluded that if it is considered the total average costs associated with the resultant hospital stay, “the cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone”. Our nowadays restrict knowledge about robotic lobectomy for lung cancer do not allow us to conclude that it is better, similar or even worse than VATS lobectomy. But we believe that in few years, their advantages are going to be proved, because it allies advantages of both open (precise articulated movements) and VATS (minimally invasive technique);