Challenges and Opportunities in Thoracic Robotic Surgery

Main Article Content

Adli Azam Mohammad Razi


Robotic surgery is a platform for minimally invasive thoracic surgery with similar general advantages as in VATS (Video Assisted Thoracic Surgery) including small incisions, faster recovery, minimal blood loss and shorter hospital stay. The extra advantages of using a robotic platform in thoracic surgery include a three-dimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. These advantages allow more complex procedures to be performed safely and easier technically, thus leading to better outcomes and improvement in the overall result. As a new advance in thoracic surgery, it has challenges that may become the reason why this technique has difficulty being adopted by a number of surgeons including cost, advancement in VATS technique and instrumentation. Despite the challenges, robotic thoracic surgery offers the platform for the expansion and improvement of thoracic surgery. Development in instrument technologies and designs, in addition to progress and interest in other futuristic technology, are notable opportunities for thoracic robotic surgery.

Keywords: Thoracic Surgery, Robotic Surgery

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How to Cite
MOHAMMAD RAZI, Adli Azam. Challenges and Opportunities in Thoracic Robotic Surgery. Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 02 oct. 2023. doi:
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1. Al-Mufarrej F, Margolis M, Tempesta B, et al. From Jacobeaus to the da Vinci: thoracoscopic applications of the robot. Surg Laparosc Endosc Percutan Tech 2010;20:1-9.
2. Petersen RP, Pham D, Burfeind WR, et al. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 2007;83:1245-9; discussion 1250.
3. Hiromitsu Nagano, Takashi Suda. Advantages and disadvantages of robotic and uniportal video-assisted thoracoscopic surgery. Video-assist Thorac Surg 2021;6:14 |
4. Ben Shanahan, Katie E. O’Sullivan, Karen C. Redmond. Robotic sleeve lobectomy-recent advances. J Thorac Dis. 2019 Apr; 11(4): 1074–1075. doi: 10.21037/jtd.2019.02.103
5. Filippo Tommaso Gallina et al. Nodal Upstaging Evaluation After Robotic-Assisted Lobectomy for Early-Stage Non-small Cell Lung Cancer Compared to Video-Assisted Thoracic Surgery and Thoracotomy: A Retrospective Single Center Analysis. Front. Surg., 01 July 2021. Sec. Thoracic Surgery.Volume 8 - 2021.
6. Ali Zamir Khan, Sangeeta Khanna et al. Robotic thoracic surgery in inflammatory and infective diseases. Ann Cardiothorac Surg. 2019 Mar; 8(2): 241–249. doi: 10.21037/acs.2019.02.05
7. Shuenn-Wen Kuo, Pei-Ming Huang et al. Robot-assisted thoracic surgery for complex procedures. Journal of Thoracic Disease. 2017 Sept. Vol 9 (9). doi: 10.21037/jtd.2017.08.11
8. Carmelina C. Zirafa, Gaetano Romano. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg. 2019 Mar; 8(2): 210–217. doi: 10.21037/acs.2019.03.03
9. PeterJ. Kneuertz, Emily Singer et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: A propensity score–weighted comparison. J Thorac and Cardiovasc Surg 2019; Volume 157(5), 2018-2026.e2.
10. Luca Bertolaccini, Gaetano Rocco. History and development of minimally invasive surgery: VATS surgery. Shanghai Chest 2019; 3:16. doi: 10.21037/shc.2019.03.01
11. Carmelina C Zirafa, Gaetano Romano. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg. 2019 Mar; 8(2): 210–217. doi: 10.21037/acs.2019.03.03
12. Bertolaccini L, Terzi A, Viti A. Why should we prefer the single port access thoracic surgery? J Vis Surg 2016;2:43.
13. Rocco G. One-port (uniportal) video-assisted thoracic surgical resections--a clear advance. J Thorac Cardiovasc Surg 2012;144:S27-31
14. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Evolving from conventional video-assisted thoracoscopic lobectomy to uniportal: the story behind the evolution. J Thorac Dis 2014;6:S599-603
15. Gonzalez-Rivas D, Sihoe ADL. Important Technical Details During Uniportal Video-Assisted Thoracoscopic Major Resections. Thorac Surg Clin 2017;27:357-72
16. Ashley R. Wilson-Smith The perioperative outcomes of uniportal robotic-assisted thoracic surgeries—a systematic review and meta-analysis of surgical cohort studies and case reports. Ann Cardiothorac Surg 2023;12(2):73-81 |
17. Sihoe ADL. Uniportal Lung Cancer Surgery: State of the Evidence. Ann Thorac Surg 2019;107:962-72
18. Gonzalez-Rivas D, Bosinceanu M, Motas N, et al. Uniportal robotic-assisted thoracic surgery for lung resections. Eur J Cardiothorac Surg 2022;62:ezac410.
19. Gonzalez-Rivas D, Manolache V, Bosinceanu ML, et al. Uniportal pure robotic-assisted thoracic surgery—technical aspects, tips and tricks. Ann Transl Med 2022
20. Alan D L Sihoe. Transition from multiportal video-assisted thoracic surgery to uniportal video-assisted thoracic surgery… and evolution to uniportal robotic-assisted thoracic surgery? Ann Cardiothoracic Surg 2023; Vol12, (2)
21. Darwich I., Abuassi M., Weiss C., Stephan D., Willeke F. The Artisential® Articulated Laparoscopic Forceps: A Dry Lab Study to Examine Dexterity and Learning Effects in Operators with Different Levels of Laparoscopic Experience. Surg. Technol. Int. 2021 doi: 10.52198/21.STI.38.SO1424
22. Rousek J.B., Brown-Clerk B., Lowndes B.R., Balogh B.J., Hallbeck S. Optimizing integration of electrosurgical hand controls within a laparoscopic surgical tool. Minim. Invasive Ther. Allied Technol. 2011;21:222–233. doi: 10.3109/13645706.2011.603340
23. Awtar S., Trutna T.T., Nielsen J.M., Abani R., Geiger J. FlexDex™: A minimally invasive surgical tool with enhanced dexterity and intuitive control. J. Med. Device. 2010;4:035003. doi: 10.1115/1.4002234
24. Hirano Y., Inaki N., Ishikawa N., Watanabe G. Laparoscopic Treatment for Esophageal Achalasia and Gastro-Esophago-reflex Disease Using Radius Surgical System. Indian J. Surg. 2012;75:160–162. doi: 10.1007/s12262-012-0559-8
25. Giovanni Parente, Eduje Thomas, Sara Cravano et al. ArtiSential® Articulated Wrist-Like Instruments and Their First Application in Pediatric Minimally Invasive Surgery: Case Reports and Literature Review of the Most Commonly Available Robot-Inspired Devices. Children (Basel). 2021 Jul; 8(7): 603. doi: 10.3390/children8070603
26. Ng CSH, Rocco Get al. Uniportal and single incision video assisted thoracic surgery—the state of the art. Interact CardioVasc Thorac Surg 2014; 19: 661–6
27. Valentina Bellini, Marina Valente. et al. Artificial intelligence in thoracic surgery: a narrative review. J Thorac Dis. 2021 Dec; 13(12): 6963–6975. doi: 10.21037/jtd-21-761
28. Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, Hoyt DB, Yang AD, Tarpley JL, Mellinger JD, Mahvi DM, Kelz RR, Ko CY, Odell DD, Stulberg JJ, Lewis FR. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med. 2016;374:713–727.
29. Akashay Gosavi, Sonia Singh et al. Nanorobotics and its application in Medicine. 2021 IJCRT; 9(7): e200-6
30. Muskan Aggarwal, Sunil Kumar. The Use of Nanorobotics in the Treatment Therapy of Cancer and Its Future Aspects: A Review. Cureus 2022; 14(9): e29366. doi:10.7759/cureus.29366
31. Cyrill Dennlee, David E. Bauer et al. Augmented reality in the operating room: a clinical feasibility study. BMC Musculoskeletal Disorders volume 22, Article number: 451 (2021)