Mini-Procedural Approaches in Thoracic Surgery: Review of procedures including LN sampling data
The minimally invasive approach is considered today the standard in the treatment of early stage lung cancer. VATS lobectomy is the most used procedure for minimally invasive lung resection; several variants have been reported from triportal-VATS to the uniportal-VATS. Robotic surgical system is the result of a long process of development aimed at producing a natural extension of the surgeon’s eyes and hands: the ease of movement obtained with open surgery is summated with the advantages of the minimally invasive technique. Robot-assisted thoracic surgery (RATS) has been adopted by an increasing number of centers around the world, and today is used in ∼10% of lobectomies in the US. To date, no randomized trials have reported comparative data on RATS vs. VATS/thoracotomy for lung cancer. Retrospective analysis comparing RATS vs. thoracotomy have revealed advantages: shorter hospital stays and a lower complication rate. A few studies have reported RATS to be safer than VATS. In addition, lymph node upstaging has been shown to be higher with RATS than with VATS. In a future perspective RATS could be used in locally advanced NSCLC and one potential advantage might be the similar radicality to open approach. The benefit of the robotic approach over open thoracotomy is related to reduced surgical trauma in fragile patients that received induction treatment. In case of occult N2 disease, RATS can translate into a shorter recovery and a quicker adjuvant treatment.