The Future of Thoracic Surgery

Abbas E. Abbas, MD, MS

Robotic systems are poised to advance thoracic surgery like never before. Many of these next steps are happening at Temple.

Pioneered in the 1980s and used commercially since the 1990s, robotic surgery is now standard of care in specialties such as urology, gynecology and colorectal surgery. Adoption has been slower in the high-acuity field of thoracic surgery—yet robotic surgery is simpler to learn than other minimally invasive techniques, and, once a surgeon develops expertise, they can operate with greater precision and several key advantages.

Increased magnification, 3-D high-definition visualization, and the ability to use very small tools with great precision allow surgeons to perform much more precise and less-invasive resections with robotics—for example, rather than a standard lobectomy for lung cancer, we are able to perform anatomical segmentectomy, leaving more healthy tissue in place. Not only that, the surgeon controls their own visualization field and is always able to use R both “hands” to perform the procedure—and those hands are steadier thanks to motion scaling, which cuts down on tremors. For these reasons, the Temple Lung Center performs robotic surgery not simply for standard cases like lung resection and esophageal surgery but also for major lung resections like pneumonectomy, chest wall resection, and the removal of large mediastinal masses.

Some safety concerns remain, as the surgeon is in a nearby control booth rather than scrubbed in; at Temple, we counter this concern by placing an experienced assistant at the bedside at all times. Indeed, the conversion rate for robotic surgery is no higher than that of other minimally invasive techniques, and most complications can be managed robotically. One other persistent concern is cost—robotic surgical systems are undoubtedly expensive. Yet, in our experience as a high-volume surgical center (data presented at AATS in 2017), robotic thoracic surgery can reduce costs by lowering the postoperative complication rate and length of hospital stay.

The future is even more exciting. The advent of tactile feedback, allowing the surgeon to feel as well as see what is happening, may increase adoption of robotic surgery. Uniportal robotic surgery is under investigation for possible use in thoracic procedures. If approved by the FDA, it may allow us to conduct procedures through a single, one-inch port using specially adapted instruments. In addition, robotic navigational bronchoscopy may soon allow us to reach and destroy lung tumors directly through a thin, flexible catheter without the need for any skin incisions. Robotic thoracic surgery will help us offer enhanced precision and less-invasive procedures to the patients who need it most.

Several robotic thoracic surgery clinical trials are taking place at Temple, including the ROMAN (VATS vs. Robotic Approach for Lobectomy or Anatomical Segmentectomy, NCT02804893) trial—an international multicenter study—and a U.S. study known as “A Retrospective Multi-Center Study for Evaluation of Clinical Outcomes with Lobectomy for Lung Cancer.” To inquire about clinical trials in robotic surgery, please contact our research department at 215-707-1359.