Robotic Thoracic Surgery

What is robotic thoracic surgery?

Robotic thoracic surgery is a type of minimally invasive surgery used in thoracic procedures for some lung cancer cases. Also called robotic-assisted thoracic surgery, it can be used to remove diseased lung tissue and possibly surrounding lymph nodes. In robotic surgery, a surgeon will sit at a console next to the patient in the operating room and control the instruments on the robotic surgical system. First, a small 3D high-definition camera is placed through one of the cuts (incisions) to provide a view of the inside of the chest cavity. Then robotic instruments are placed through the other small incisions made in between the ribs. The robotic instruments are completely controlled by the doctor’s hands at the console. The surgeon removes lung tissue through one of the incisions. The magnified view and wristed instruments allow the surgeon to make precise, controlled movements to remove lung tissue without having to make larger incisions to open up the chest or spread the ribs. The robotic technique can be used for other types of chest procedures involving the lungs, esophagus, thymus, and certain cardiac procedures, besides lung cancer surgery.

Learn more about surgical techniques and other types of lung cancer surgery here. 

What to expect?

• Your doctor will discuss with you what you need to do to prepare for surgery.
• Your surgery will begin with you being placed under general anesthesia.
• Once you are asleep, a breathing tube is placed into your airway to allow each lung to be separately inflated during surgery.
• You are then positioned on your side.
• The surgeon will typically make four small cuts (incisions) between your ribs so they can access your thoracic (chest) area using the robot.
• The surgical assistant will place the instruments and cameras attached to the “arms” of the robot into the incisions.
• The surgeon sits at a control console nearby where they can see magnified, clear images of the surgical area.
• The robot responds in real-time to the surgeon’s hand movements as the surgeon removes the diseased part of the lung and possibly lymph nodes.
• At the end of the surgery, the surgeon will insert a chest tube through one of the small incisions to drain fluid or air leaking into the chest cavity and help your lungs re-inflate. This tube will be removed by your care team as you recover.
• Minimally invasive surgery often means a shorter recovery time and patients are usually discharged from the hospital sooner
• Follow any post-operative instructions from your doctor.

It is important to give yourself time to rest when you go home. Gradually you will get stronger and feel like yourself.

Read our “Robotic-assisted Thoracic Surgery Play by Play" blog for a more detailed explanation of the procedure.

What are the risks and benefits?

All types of surgery carry risks. They may include but are not limited to blood clots, infection, bleeding, abnormal heartbeats, air leakage from your lungs and pain. Robotic thoracic surgery may be associated with longer operative times and a longer time under anesthesia. Your surgeon may have to convert to a more invasive approach, if needed, to complete the surgery.

There are also benefits compared to open chest surgery through a thoracotomy:

• The robotic tools are precise and maneuverable. The camera also allows the surgeon to get a clear picture of the chest during the surgery and to access parts of the chest that can be difficult to reach.
• Minimally invasive surgery may mean less blood loss, faster recovery times, and fewer complications.

Each person handles surgery differently and your outcomes may depend on a number of factors, like your health history, the type of lung cancer you have, the planned procedure and/or your surgeon's experience.

Who is eligible?

Eligibility for robotic thoracic surgery is determined on a case-by-case basis by your care team. Generally, patients are eligible for lung cancer surgery as a first-line treatment if they have early stage disease (stage 1 or 2). Sometimes patients will receive lung cancer surgery after another type of treatment like chemotherapy or radiation is used to shrink the tumor. When you are considering a lung surgery, it’s best to find a surgeon well-trained in minimally invasive surgical techniques. A highly skilled surgeon can perform surgery in a variety of ways and will explain which is the best option for your particular case.