Robotic thoracic surgery, that is, robot-assisted surgery of the chest, involves performing certain procedures in the chest cavity through small ports, using the Da Vinci robotic system. Instruments that reproduce the human wrist, intuitive control of movements and high-resolution three-dimensional images help the surgeon to overcome the limits of conventional open or thoracoscopic surgical techniques. This approach makes it possible to perform more complex procedures. The Da Vinci model consists of three main components:
- The surgeon's console
- The patient unit with 4 interactive arms
- The high-resolution three-dimensional imaging panel
Seated at the console, the surgeon observes the three-dimensional image of the operating field. The system measures the movements of the surgeon's hand and, after filtering them, transmits them to the interactive robotic arms. The micro-movements of the Da Vinci instruments are controlled by the system's computer processor. The small, precise "hands" of the Da Vinci offer a range of movement that exceeds the limits of the human wrist and thus make it possible to perform manoeuvres that are impossible with conventional laparoscopic and thoracoscopic instruments. Each Da Vinci arm, with a movement capacity of 540 degrees, allows the surgeon to work with more precision than the 180-degree movement of the human hand.
Applications in thoracic surgery
Thoracic applications include the surgical removal of an entire lung (pneumonectomy), of one of its lobes (lobectomy) or of one of its segments (segmentectomy). The robot can also be used successfully in procedures on the oesophagus, as well as in procedures involving cysts and masses located in the region between the lungs known as the mediastinum.
How does robotic thoracic surgery differ from video-assisted thoracoscopy?
In video-assisted thoracoscopy, two-dimensional vision causes a loss of depth perception; this can weaken hand-eye coordination and increase the risk of serious complications when manipulating close to vital organs. Robotic surgery, on the other hand, offers 10 to 12 times magnification and three-dimensional vision. In addition, video-assisted thoracoscopy instruments are limited in their range of movement; robotic instruments, thanks to their wrist mechanism capable of moving through 540 degrees, have great freedom of manoeuvre and are therefore more effective in complex procedures.
The benefits for the surgeon and the patient
This offers the patient less pain, a smaller scar, a shorter hospital stay, reduced blood loss, fewer complications, a shorter recovery and a faster return to the normal activities of daily life; and the surgeon, high-resolution three-dimensional vision, a better range of movement, and safer and more comfortable handling throughout the procedure, in a seated position.
Can robotic surgery be used in patients with cancer?
Ideal patients are those with a tumour of less than 5 cm located in a single lobe of the lung. In this group of patients, lobectomy and removal of the mediastinal lymph nodes — which is essential for patients with cancer — can be performed safely, in accordance with oncological principles. Cases of complete removal of the lung have also been reported. Specialists stress that, as experience in robotic surgery grows, more complex and more invasive procedures will become possible.
Altan Kır
Assoc. Prof. Dr. in Thoracic Surgery
Cardiovascular and Thoracic Health – Thoracic Surgery
Altan Kır
Assoc. Prof. Dr. in Thoracic Surgery
Cardiovascular and Thoracic Health – Thoracic Surgery
Education and experience
- Karadeniz University Faculty of Medicine, Trabzon
- Department of Thoracic Surgery, Dicle University Faculty of Medicine, Diyarbakır
- Royal Brompton Hospital, England
- Memorial Sloan Kettering Cancer Center, USA
- Süreyyapaşa Chest Diseases and Thoracic Surgery Centre, Istanbul
- Areas of expertise and medical interests
- Tracheobronchial resections, sleeve technique (bronchoplasty).
- Extended resections
- Paediatric thoracic surgery
Research and publications
- 15 international articles, 30 national articles
- 45 presentations
- 2 book chapters