Robot-assisted thoracic surgery for lung cancer: training and clinical applications

Abstract

This dissertation critically evaluates the role of robot-assisted thoracic surgery (RATS) in the surgical management of patients with lung cancer.

The General Introduction gives a comprehensive overview of lung cancer treatment, the development and role of RATS compared to the video-assisted thoracoscopic surgery as well as the expanding clinical applications. Furthermore, a critical appraisal of the limitations, challenges and inherent drawbacks of the robotic platform are discussed.

Following the General Introduction is Part I, which describes several training aspects of a RATS and how to set up a RATS program. Training for specific robotic technical skills as well as non-technical skills during RATS are highlighted.

In Part II clinical applications are addressed. These concern the quality of RATS for lymph node dissection, the feasibility of RATS for resections for higher stages lung cancer, for a small sized chest of an adolescent and for complex re-do surgery. Lastly, future directions are given regarding technological advancements, robotic navigation bronchoscopy, artificial intelligence applications as well as safety in the operating room, equity and sustainability. We conclude that continuous monitoring of patient outcomes, cost-efficiency and safety must guide integration of new technologies. Nevertheless, the momentum for robotic surgery is accelerating and its widespread implementation appears inevitable.