Giulia Veronesi1. 1. Division of Thoracic Surgery-European Institute of Oncology, Milan, Italy. giulia.veronesi@ieo.it
Abstract
PURPOSE OF REVIEW: Video-assisted thoracic surgery (VATS) is a minimally invasive approach with several advantages over open thoracotomy for resectable lung cancer. However, VATS use is limited mainly because of rigid instruments and limited vision. Robot technology appears to overcome these limitations. This review examines the recent literature on the only commercially available robotic system (da Vinci) and comparatively assesses its advantages and disadvantages for the treatment of lung cancer. RECENT FINDINGS: Retrospective studies demonstrate that robot-assisted lobotomy is feasible and safe. Limited long-term results indicate oncological radicality similar to that of open and VATS approaches. Several different robotic techniques are currently employed. Indications for robotic lung resection may be more extensive than those for VATS. SUMMARY: Randomized controlled trials are not available. Robot-assisted approaches to lung cancer resection and lymph node dissection appear to offer comparable radicality and safety to VATS and open surgery. More intuitive movements, greater flexibility and high-definition, three-dimensional vision render surgery easier for the surgeon, with shorter learning curve than VATS. High capital and running costs, limited instrument availability and long operating times are important disadvantages. Entry of competitor companies should drive down costs. Studies are required to assess quality of life, morbidity, oncological radicality and cost-effectiveness.
PURPOSE OF REVIEW: Video-assisted thoracic surgery (VATS) is a minimally invasive approach with several advantages over open thoracotomy for resectable lung cancer. However, VATS use is limited mainly because of rigid instruments and limited vision. Robot technology appears to overcome these limitations. This review examines the recent literature on the only commercially available robotic system (da Vinci) and comparatively assesses its advantages and disadvantages for the treatment of lung cancer. RECENT FINDINGS: Retrospective studies demonstrate that robot-assisted lobotomy is feasible and safe. Limited long-term results indicate oncological radicality similar to that of open and VATS approaches. Several different robotic techniques are currently employed. Indications for robotic lung resection may be more extensive than those for VATS. SUMMARY: Randomized controlled trials are not available. Robot-assisted approaches to lung cancer resection and lymph node dissection appear to offer comparable radicality and safety to VATS and open surgery. More intuitive movements, greater flexibility and high-definition, three-dimensional vision render surgery easier for the surgeon, with shorter learning curve than VATS. High capital and running costs, limited instrument availability and long operating times are important disadvantages. Entry of competitor companies should drive down costs. Studies are required to assess quality of life, morbidity, oncological radicality and cost-effectiveness.