Robotic surgery offers many advantages compared with traditional open procedures, but is not widely used to date. Many types of pulmonary resections can be completed laparoscopically, for example lobectomy(?) and pneumonectomy. For pneumonectomy, VATS is appropriate. For lobectomy(?), VATS is less advantageous because of cost and operative time. It would appear to offer advantages with limited and selected cases, such as pneumonectomy, and in a highly selected patient group.
Robotic lung surgery involves several potential risks, including a large learning curve for surgeons unfamiliar with robotic methods of lung surgery and the need to learn surgical techniques in a foreign environment. A careful history and an examination for clinical signs of lung cancer is essential. The current guidelines to screen patients in the United States should be adapted to robotic lung surgery.
Robotic systems simplify and reduce costs, as well as reducing manual effort, in any procedure that is laparoscopic-based. For many indications robotics is as effective or possibly better than laparoscopy.
Few surgeons are performing RLS or are attempting RLS at all. These data have implications for the utilization of a system where the surgeon utilizes telemedicine to consult with a general surgeon to assess surgery eligibility and a general anaesthesia provider to perform a consultation with the patient to determine the indication for RLS. Additionally, we found a potential avenue for future training programs to assess the learning phase of robotic lung surgery to determine the best method of delivering robotic lung surgery training in the United States.
Laparoscopic pneumonectomy after a prior failed open procedure is a real option in selected patients, but surgical mortality is not decreased compared to that observed after an open pulmonary wedge resection with bilateral pulmonary artery grafting during the initial operation. The robotic approach can offer a significant improvement in surgeon exposure and mobility, giving the best conditions to operate on a very elderly frail patient population.
The development of robotic technology may assist in reducing the risk for complications caused by open lung surgery (lung cancer and pulmonary metastasectomy), but it will not eliminate them. The increased risk for postoperative complications requires careful consideration. The study presented here can help surgeons to select the most appropriate minimally invasive surgical procedure by choosing the most appropriate implantable device according to their specific pathologies.
Results from a recent clinical trial revealed that a significant percentage of robotic lung resection had to be performed for pathologic entities other than SIR. The most common causes were tumors and infection. Further studies are needed to identify and prevent problems associated with robotic lung surgery.
In this pilot, large institutional, multi-institutional trial, wound infiltration with 0.25% bupivacaine-epinephrine solution mixed with 20 mg dexamethasone resulted in similar pain control without increased complication rates, and may represent a favorable alternative for analgesia and wound infiltration in people undergoing minimally invasive lung surgery.
Robotic lung surgery enables minimally invasive, low-level anesthesia and an easier thoracoscopy and VATS approach for surgical lung cancer. The robotic approach will enable patients of low economic status and will lead to improving their quality of life after a surgery.
Lung surgery can be successfully performed using a robot. However, surgeons have a number of variables that may make it difficult for them to accurately decide whether a patient should participate in a clinical trial.
The IONB was found to be one of the most effective single-bundle block techniques in the present study, especially for alleviating pain and promoting recovery of normal pulmonary function, with no negative clinical effect upon a well-managed patient population. Based upon our findings, we consider the IONB to be useful to complement other regional anesthesia techniques.