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Special Issue "Adoption of Robotics in Thoracic Surgery"

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (15 August 2023) | Viewed by 8122

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Dr. Takashi Eguchi

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Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Interests: complex lung segmentectomy; lung cancer; minimally invasive surgery; perioperative risk assessment; robotic surgery; spread through air spaces (STAS)
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Dear Colleagues,

Over the past three decades, technical advances in the field of minimally invasive surgery have been exploding. One of the most revolutionary advances has been the development of the robotic surgical system. Recently, the robot-assisted thoracic surgery (RATS) approach has been widely adopted with several reported advantages, including enhanced three-dimensional visualization, improved dexterity of instrumentation, and ergonomic design, which are believed to help us provide patients with more precise and effective surgery. However, concerns have been raised regarding the increased cost and potentially non-increased effectiveness of RATS compared with other established minimally invasive thoracic surgical approaches such as traditional video-assisted thoracic surgery. This Special Issue of the Journal of Personalized Medicine aims to highlight the current status and future perspectives of robotics in the field of thoracic surgery. The technical and scientific advances in minimally invasive thoracic surgery will continue to move forward with personalized and optimal treatment for thoracic malignancies.

Dr. Takashi Eguchi
Guest Editor

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Keywords

lobectomy
lung cancer
minimally invasive surgery
robot-assisted thoracic surgery
segmentectomy
thoracic surgery
thymectomy
video-assisted thoracic surgery

Published Papers (5 papers)

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Editorial

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2 pages, 164 KiB

Open AccessEditorial

Personalized Medicine in Thoracic Surgery: The Role and Future of Robotic-Assisted Techniques

Takashi Eguchi

J. Pers. Med. 2023, 13(6), 986; https://doi.org/10.3390/jpm13060986 - 13 Jun 2023

Viewed by 520

Abstract

The advent of robotic-assisted thoracic surgery (RATS) has revolutionized the field of thoracic surgery, offering a new paradigm for personalized, precision, and individualized medicine [...] Full article

(This article belongs to the Special Issue Adoption of Robotics in Thoracic Surgery)

Research

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12 pages, 2725 KiB

Open AccessArticle

Three-Arm Robotic Lung Resection via the Open-Thoracotomy-View Approach Using Vertical Port Placement and Confronting Monitor Setting: Focusing on Segmentectomy

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J. Pers. Med. 2022, 12(11), 1771; https://doi.org/10.3390/jpm12111771 - 27 Oct 2022

Cited by 2 | Viewed by 1530

Abstract

To perform robotic lung resections with views similar to those in thoracotomy, we devised a vertical port placement and confronting upside-down monitor setting: the three-arm, robotic “open-thoracotomy-view approach (OTVA)”. We described the robotic OTVA experiences focusing on segmentectomy and its technical aspects. We retrospectively reviewed 114 consecutive patients who underwent robotic lung resections (76 lobectomies and 38 segmentectomies) with OTVA using the da Vinci Xi Surgical System between February 2019 and June 2022. To identify segmental boundaries, we administered indocyanine green intravenously and used the robotic fluorescence imaging system (Firefly). In all procedures, cranial-side intrathoracic structures, which are often hidden in the conventional look-up-view method, were well visualized. The mean durations of surgery and console operation were 195 and 140 min, respectively, and 225 and 173 min, for segmentectomy and lobectomy, respectively. In segmentectomy, console operation was significantly shorter (approximately 30 min, p < 0.001) and two more staplers (8.2 ± 2.3) were used compared with lobectomy (6.6 ± 2.6, p = 0.003). In both groups, median postoperative durations of chest tube placement and hospitalization were 0 and 3 days, respectively. This three-arm robotic OTVA setting offers natural thoracotomy views and can be an alternative for segmentectomy and lobectomy. Full article

(This article belongs to the Special Issue Adoption of Robotics in Thoracic Surgery)

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10 pages, 24562 KiB

Open AccessArticle

Robotic Mediastinal Tumor Resections: Position and Port Placement

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J. Pers. Med. 2022, 12(8), 1195; https://doi.org/10.3390/jpm12081195 - 22 Jul 2022

Cited by 3 | Viewed by 2555

Abstract

This study aimed to determine the optimal position and port placement during robotic resection for various mediastinal tumors. For anterior mediastinal tumors, total or extended thymectomy is commonly performed in the supine position using the lateral or subxiphoid approach. Although it is unclear which approach is better during robotic thymectomy, technical advantages of subxiphoid approach are beneficial for patients with myasthenia who require extended thymectomy. Partial thymectomy is performed in the supine position using a lateral approach. Superior, middle, and posterior mediastinal tumors are resected in the decubitus position using the lateral approach, whereas dumbbell tumor resection, which requires a posterior approach, can be performed in the prone position. The position and port placement should be chosen depending on the size, location, and aggressiveness of the tumor. In this study, we describe how to choose which of these different robotic approaches can be used based on our experience and previous reports. Full article

(This article belongs to the Special Issue Adoption of Robotics in Thoracic Surgery)

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Review

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20 pages, 8920 KiB

Open AccessReview

Port Placement Variations for Robotic Lung Resection: Focusing on Their History, Conventional Look-Up-View and Horizontal Open-Thoracotomy-View Techniques, and More

Noriaki Sakakura

and

Takashi Eguchi

J. Pers. Med. 2023, 13(2), 230; https://doi.org/10.3390/jpm13020230 - 27 Jan 2023

Cited by 2 | Viewed by 1276

Abstract

This is a narrative review that summarizes the variations in approaches and port placements used for performing robotic lung resections on the da Vinci Surgical Platforms. Currently, the four-arm, look-up-view method, in which the intrathoracic cranial side is viewed from the caudal side, is considered the mainstream approach worldwide. Several variations were devised from this conventional technique, including the so-called horizontal open-thoracotomy-view techniques in which the intrathoracic craniocaudal axis is aligned with the horizontal direction of the console monitor, and fewer port and incision techniques. In September 2022, 166 reports were surveyed using a PubMed English literature search, and this review finally included 30 reports describing the approaches. We categorized the variations into four-phase groups considering advent histories: (I) early era, three-arm technique with utility incisions; (II) four-arm, total port technique without robotic staplers; (III) four-arm technique using robotic staplers; (IV) maximizing the functional features of the Xi, significant alterations in viewing directions, and reducing ports, including the ultimate uniport technique. To comprehensibly visualize these variations for practical use, we created elaborate illustrations based on the literature. The familiarity of thoracic surgeons with the variations and characteristics allows them to choose the optimal procedure that best suits each patient and their preferences. Full article

(This article belongs to the Special Issue Adoption of Robotics in Thoracic Surgery)

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Other

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12 pages, 2795 KiB

Open AccessSystematic Review

Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer

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J. Pers. Med. 2022, 12(8), 1311; https://doi.org/10.3390/jpm12081311 - 12 Aug 2022

Cited by 6 | Viewed by 1528

Abstract

(1) Background: Conventional open thoracotomy has been the accepted surgical treatment for resectable non-small cell lung cancer. However, newer, minimally invasive approaches, such as robotic surgery, have demonstrated similar safety and efficacy with potentially superior peri-operative outcomes. The present study aimed to quantitatively assess these outcomes through a meta-analysis. (2) Methods: A systematic review was performed using electronic databases to identify all of the relevant studies that compared robotic surgery with open thoracotomy for non-small cell lung cancer. Pooled data on the peri-operative outcomes were then meta-analyzed. (3) Results: Twenty-two studies involving 12,061 patients who underwent robotic lung resection and 92,411 patients who underwent open thoracotomy were included for analysis. Mortality rates and length of hospital stay were significantly lower in patients who underwent robotic resection. Compared to open thoracotomy, robotic surgery was also associated with significantly lower rates of overall complications, including atrial arrhythmia, post-operative blood transfusions, pneumonia and atelectasis. However, the operative times were significantly longer with robotic lung resection. (4) Conclusions: The present meta-analysis demonstrated superior post-operative morbidity and mortality outcomes with robotic lung resection compared to open thoracotomy for non-small cell lung cancer. Full article

(This article belongs to the Special Issue Adoption of Robotics in Thoracic Surgery)

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