Evolution of Lobectomy for Lung Cancer: From Open to Robotic Surgery
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 19, Issue 1
Abstract
The surgical approach to lung resection has continued to evolve over time, gaining a momentum of success with each surgical advance. A rapidly developing area is the singleport (uniport) video-assisted thoracoscopic surgery (VATS). The single-port approach has been in practice for wedge resections over a decade. In the last 10 years, single-port VATS has extended its application to major lung resections, including lobectomies for the resection of proven or suspected lung tumours. The use of a small surgical incision has proven to have benefits ranging from reduced post-operative pain to even being able to undergo these procedures without general anaesthesia. This has in turn led to the field of robotic thoracic surgery to gain a surge in popularity, which benefits also from the advantages of performing complex operations with the creation of a small incisions. With the shared goal of attaining a limited post-operative hospital stay, lower health care costs, reduced post-operative complications and increasing productivity; we aim to review the reported literature of current use of each surgical technique to perform lobectomies and the development in their ability to accomplish these.The development of minimally invasive techniques for lung resection have followed a thrilling and complicated course. Although thoracoscopy is at present viewed as a modern advance in lung cancer surgeries, the groundwork was laid by the Swedish physician Jacobeus in the late 19th century, in the same period that the first elective open lobectomies were attempted [1]. In his revolutionary paper, he described the three cornerstones of our current minimal invasive techniques: minimal tissue trauma and pain with trocar placement, use of a transparent medium in the cavity and the need for a scope thin enough to be placed through the trocar [2]. It was not until four decades later that a panoramic view of the thorax was achieved through the use of a light source and red lens with micro cameras and video systems. Whilst initially these were in use for diagnostic purposes only, in the mid-1980s this led to the application of these principles to thoracic surgery [1,2]. The traditional open approach to lobectomy and other procedures is associated with significant pain that may be long-lasting in duration, primarily from rib-spreading. Video-assisted thoracic surgery (VATS) provided the potential advantage of minimising access and therefore post-operative pain. By the mid 1990s interest in VATS grew and it took over as the preferred technique for many operations including lobectomy [1]. Compared to open thoracotomy, VATS has been shown to minimise post-operative pain, reduce post-operative complications, reduce the duration of chest tube use, limit length of stay, and improve post-operative quality of life of patients [1]. It has become so widely practiced that it is no longer novelty, but rather a conventional approach to performing thoracic surgery [3]. The original practice of three access ports in a ‘baseball diamond’ pattern in traditional approach to VATS however has been modified over time, to ‘next generation’ approaches such as 2-port VATS and uniportal procedures [3]. This has led to significant implications as to how the thoracic surgeon ought to master and execute the full potential of the uniportal technique. The use of the da Vinci robot system (intuitive Surgical, Sunnyvale, CA) in minimally invasive thoracic surgery has gained popularity also due to its ability to enable 3D vision, improve dexterity, enable steady use of instruments, and increase precision in the area of interest. However, this precision comes at the expense of at times requiring an extra fourth port [3].
Authors and Affiliations
Christiana Bithas, Amer Harky
Keywords
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- EP ID EP622375
- DOI 10.26717/BJSTR.2019.19.003244
- Views 135
- Downloads 0
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