Figure 3 - uploaded by Michael Argenziano
Content may be subject to copyright.
Source publication
While robotic technology is gaining popularity in cardiac surgery, it also is being used to facilitate thoracoscopic procedures, such as insertion of phrenic pacemakers and resection of mediastinal masses. This report describes the use of robotic technology in performing thoracoscopic lobectomy.
One patient underwent a left lower lobectomy with the...
Context in source publication
Context 1
... da Vinci robotic system (Intuitive Surgical, Mountain View, CA, USA) consists of a surgeon's control console and a surgical arm unit that positions and maneuvers detachable surgical instruments (Figure 3). A patient-side surgeon assists with exchange of robotic instruments through the trocar unit. Endoscopic instruments include various forceps, scissors, clip applier, electrocautery, and ultrasonic shears. From the con- sole, the surgeon has a 3-dimensional, magnified, stereoscopic view of the operative field. The surgeon telemanipulates the ...
Similar publications
The preceding description of E-CABG may seem excessively detailed, even redundant, for trained cardiac surgeons; however, the authors' extensive experience with training surgeons on endoscopic techniques suggests that, despite a high level of proficiency and dexterity that a surgeon may possess in open surgery, becoming equally proficient and dexte...
Citations
... It has some advantages over VATS, thanks to the three-dimensional optics used in RATS and robotic arms that contain tools that can facilitate complex movements. There are studies show that it affects the length of hospital stay, intra and postoperative complication rates, etc. [12][13][14]. On the other hand, RATS also has disadvantages such as higher costs and longer operation time [15]. ...
Background
In recent years, conventional thoracoscopic surgery has been accepted as the traditional treatment method in the non-small cell lung cancer (NSCLC). VATS and RATS, which are the techniques of this surgical method, have been increasing their effectiveness and applicability of late years. The aim of this bibliometric analysis is to evaluate the importance and efficiency of articles comparing VATS and RATS techniques.
Materials and methods
Studies comparing VATS and RATS published between 1997 and 2021 were identified in the Web of Science database (accessed on 31. 12. 2021). The 40 most cited studies were analyzed in terms of publication years, country of study, authors, institutions that the authors were affiliated with, journal, journal address and impact factor.
Results
While an article was cited a maximum of 187 times when the citations made by the authors were excluded from the analysis, it was observed that all publications were cited a total of 1946 times. It was seen that an average of 51. 30 ± 47. 73 (8–187) articles were cited. In the 25-year, the highest number of publications was reached in 2019, while eight articles were published this year. The Annals of Thoracic Surgery (n = 13, 32. 5 %) was the journal in which the articles in the list were published the most. Most of the articles in our study (n = 31, 77.5 %) were published in US journals. While many studies presented more than one topic and analysis, the topic of most interest in 19 (47.5 %) studies was postoperative complications.
Conclusion
This bibliometric analysis reflects important and qualified articles comparing VATS and RATS technique in thoracic surgery, but it can also be used to explain or explain the performance and results of these techniques, their positive and negative aspects, and their superiority over each other.
... RATS lobectomy appears to present some advantages over VATS approach, [10][11][12] including three-dimensional optics, small-wristed instrument motions, which can facilitate complex movements in a closed space, and influences both intraoperative complication and postoperative outcomes. [13][14][15] On the other hand, in spite of the aforementioned advantages of RLS there are several controversial aspects of this approach, such as higher hospital costs and longer procedure times may restrict the RATS. [16] A relatively new minimally invasive technique introduced to thoracic surgery is using the robotic Da Vinci surgical system. ...
To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.
A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.
Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).
Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.
... Robotic lobectomy received US Food and Drug Administration approval in 2000 and was first used for lung cancer in 2003. Since then, the numbers of robotic lobectomies and the numbers of centers performing robotic lobectomy have dramatically increased (7)(8)(9)(10). Robotic surgery has several advantages over alternative techniques, including three-dimensional, magnified visualization, the use of an articulating instrument, scaled motion, hand tremor damping and intuitive movement (7). ...
Background:
Robotic surgery is known to have several advantages including magnified three-dimensional vision and angulation of the surgical instruments. To evaluate the feasibility and efficiency of robotic lobectomy in the treatment of lung cancer, we analyzed the outcomes of our initial experiences with robotic lobectomy at a single institution in Korea.
Methods:
Eighty-seven patients with lung cancer underwent robotic lobectomy (robotic group: 34 patients) and video-assisted thoracic surgery (VATS) lobectomy (VATS group: 53 patients) between 2011 and 2016 at our hospital. The medical records of these patients were retrospectively analyzed.
Results:
The operation times of the two groups were significantly different (robotic group, 293±74 min; VATS group, 201±62 min; P<0.01). Intraoperative blood loss occurred more in the robotic group than in the VATS group (robotic group, 403±197 mL; VATS group, 298±188 mL; P=0.018). The numbers of lymph nodes dissected in the two groups were significantly different (robotic group, 22±12; VATS group, 14±7; P<0.01). There was no intraoperative mortality in both groups.
Conclusions:
Despite the initial difficulties, robotic lobectomy for lung cancer was a safe and feasible procedure with no operative mortality. If operation time and intraoperative blood loss improve as the learning curve progresses, robotic surgery may overcome the limitations of VATS in lung cancer surgery.
... Minimally invasive thoracic surgery witnessed exponential growth when the Food and Drug Administration approved robotic approaches for thoracic surgery in 2000. Institutions began reporting single center experiences with robotic thoracic surgery via the da Vinci Surgical System (Intuitive Surgical; Sunnyvale, CA) (1)(2)(3). Studies have shown the robot is safe and efficacious with equitable outcomes compared to traditional thoracoscopic approaches (4)(5)(6)(7)(8)(9). Since the inception of robotic assisted thoracoscopic surgery debate exists regarding the utility of robotic approaches related to cost and value, however, the application to thoracic procedures continues to expand from mediastinal resections to lobectomies. ...
... [8][9][10] Moreover, proponents of robotic surgery claim additional benefits of improved ergonomics, three-dimensional optics, and wristed instrument motions, which may allow for a more thorough lymph node dissection. [11][12][13] On the other hand, opponents of robotic surgery have cited increased costs and longer procedure times. 14 Despite a growing body of literature regarding robotic lobectomy, there is a paucity of information on whether or not there are advantages to transitioning to robotics by surgeons who are already proficient in performing VATS lobectomy. ...
... Systematic mediastinal and hilar lymph node dissections were performed for all cases. Lymph node stations addressed typically included paratracheal (4R), tracheobronchial angle (10R), subcarinal (7), interlobar (11) and infrahilar (9) for right-sided resections and periaortic (5), subcarinal (7), tracheobronchial angle (10L), interlobar (11), and infrahilar (9) for left-sided resections. Specimens were placed in impervious bags (Endocatch II 15-mm specimen pouch, Covidien, Norwalk, Conn). ...
To determine if there are advantages to transitioning to robotics by a surgeon who is already proficient in performing video-assisted thoracic surgical (VATS) lobectomy.
A single surgeon proficient in VATS lobectomy initiated a robotic lobectomy program, and a retrospective review was conducted of his patients undergoing minimally invasive lobectomy (robotics or VATS) for lung cancer between 2011 and 2012. Data collected included patient/tumor characteristics, morbidity, mortality, operative times, and length of hospital stay.
Over a 24-month period, a total of 69 patients underwent minimally invasive lobectomy (35 robotic, 34 VATS). Patients in each group were similar in age and clinical stage. Robotic upper lobectomy operative times were longer than VATS (172 vs 134 minutes; P = .001), with no significant difference in lower lobectomies noted (140 vs 123 minutes; P = .1). Median length of stay was 3 days in both groups, and the median number of lymph nodes harvested was 18 (robotic) versus 16 (VATS; P = .42). Morbidity and mortality for robotic versus VATS were 11% versus 18% (P = .46) and 0% versus 3% (P = .49), respectively.
There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes. The learning curve for robotic upper lobectomies seems to be more significant than that for lower lobectomies.
... Surgical robots have been shown to improve MIS efficiency by providing superior three-dimensional (3D) magnification, enhanced dexterity, and improved precision by tremor filtration and motion scaling [45][46][47][48]. To the surgeon, surgical robots also offer improved ergonomics, instrument dexterity during VATS, and the opportunity to operate via telesurgery at a safer distance from the radioactive source [49]. Surgical use of robotics, or computer-assisted surgical systems (CAS), has evolved over the last 10 years for the treatment of chest diseases, however, significant development has really only occurred in the last 3 to 4 years. ...
New technological concepts have been evolving to manage the relative poor prognosis of lung cancer. Brachytherapy is becoming an option for both unresectable and early resectable lung cancer. Three-dimensional ultrasound (US) of lung tumours and image-guided minimally invasive robotics-assisted brachytherapy are feasible for dosimetry planning and management of lung tumours. The present article reviews the current knowledge of lung brachytherapy and discusses its potential in future management of lung cancer.
... If the da Vinci ® Surgical System could be applied to lung and mediastinal surgery, the field of thoracic surgery would benefit from the advantages of both standard thoracotomy and VATS. [4][5][6][7][8][9][10][11][12][13][14][15][16] However, very few institutions perform robot-assisted thoracic surgery routinely. In particular, there is only one report of robotically operated lung cancer. ...
In Japan, as of March 2010, only 13 hospitals were using the da Vinci® system and only for selected cases. Few clinical robotic lung surgery has been done in Japan, and there are no standardized training programs, although some exist in the U.S. and are under consideration by the Japanese society for thoracic surgery. We have used the da Vinci S® Surgical System for pneumonectomy and lymph node dissection in pigs. We report and review future possibilities and problems of robotic surgery, especially concerning education, training, safety management and ethical considerations for pneumonectomy and lymph node dissection in clinical practice.
The da Vinci® system consists of a surgeon's console connected to a patient-side cart, a manipulator unit with three instrument arms and a central arm to guide the endoscope. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transmit the surgeon's movements to the instrument arm.
We experienced exactly the same sensation as when performing standard open thoracotomy. Visual recognition is 3-D, and the high manipulation potential allows free movement of the various accessory instruments, exceeding the capacity of a surgeon's hands in video-assisted thoracic surgery (VATS) or even standard thoracotomy.
Robotic surgery achieves at least the same level of operation technique for pneumonectomy and lymph node dissection under standard open thoracotomy, and it seemed as safe and easily performed as conventional VATS. The training program using pigs was effective and holds promise as a system to train thoracic surgeons in robotic lung surgery.
... However, techniques for robotic-assisted upper lobectomy have not been reported. [2][3][4] This may be related to increased operative difficulty and proper positioning of the robotic system. Upper lobectomy is anatomically more difficult than lower lobectomy because the main pulmonary artery as well as the pulmonary vein must to be carefully dissected from surrounding tissue and several branches of the pulmonary artery divided. ...
Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade.
