Robotic thoracic surgery technical considerations and learning curve for pulmonary resection

Telerobotic surgery systems confer several technical advantages over traditional manual videothoracoscopic surgery, such as more intuitive movements, greater flexibility, and high-definition three-dimensional optics. These technologic advances can overcome certain limitations of VATS and may encourage wider adoption of minimally invasive approaches for the surgical treatment of thoracic disease. There are variations in robotic techniques for anatomic lung resection in terms of number of incisions, use of a utility incision versus a total port approach, and use of CO₂ insufflation. However, regardless of technique there is growing evidence to indicate that robot-assisted approaches to minimally invasive lung resection offer comparable radicality and safety to VATS and open surgery. Ongoing prospective studies are required to assess for differences between robotic, VATS, and open approaches with respect to long-term outcomes, oncologic efficacy, quality of life, and cost implications.