Tung Kaity H, Yendamuri Sai, Seastedt Kenneth P
Department of Surgery, University at Buffalo, Buffalo, NY 14203, USA.
Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
J Clin Med. 2024 Sep 27;13(19):5764. doi: 10.3390/jcm13195764.
With the paradigm shift in minimally invasive surgery from the video-assisted thoracoscopic platform to the robotic platform, thoracic surgeons are applying the new technology through various commonly practiced thoracic surgeries, striving to improve patient outcomes and reduce morbidity and mortality. This review will discuss the updates in lung resections, lung transplantation, mediastinal surgeries with a focus on thymic resection, rib resection, tracheal resection, tracheobronchoplasty, diaphragm plication, esophagectomy, and paraesophageal hernia repair. The transition from open surgery to video-assisted thoracoscopic surgery (VATS) to now robotic video-assisted thoracic surgery (RVATS) allows complex surgeries to be completed through smaller and smaller incisions with better visualization through high-definition images and finer mobilization, accomplishing what might be unresectable before, permitting shorter hospital stay, minimizing healing time, and encompassing broader surgical candidacy. Moreover, better patient outcomes are not only achieved through what the lead surgeon could carry out during surgeries but also through the training of the next generation via accessible live video feedback and recordings. Though larger volume randomized controlled studies are pending to compare the outcomes of VATS to RVATS surgeries, published studies show non-inferiority data from RVATS performances. With progressive enhancement, such as overcoming the lack of haptic feedback, and future incorporation of artificial intelligence (AI), the robotic platform will likely be a cost-effective route once surgeons overcome the initial learning curve.
随着微创手术范式从电视辅助胸腔镜平台向机器人平台转变,胸外科医生正在通过各种常见的胸外科手术应用这项新技术,努力改善患者预后并降低发病率和死亡率。本综述将讨论肺切除术、肺移植、纵隔手术的进展,重点关注胸腺切除术、肋骨切除术、气管切除术、气管支气管成形术、膈肌折叠术、食管切除术和食管旁疝修补术。从开放手术到电视辅助胸腔镜手术(VATS)再到如今的机器人辅助电视胸腔镜手术(RVATS)的转变,使得复杂手术能够通过越来越小的切口完成,借助高清图像实现更好的可视化以及更精细的游离,完成以前可能无法切除的手术,缩短住院时间,减少愈合时间,并扩大手术适应证范围。此外,更好的患者预后不仅通过主刀医生在手术中所能做到的来实现,还通过可获取的实时视频反馈和录像对下一代进行培训来实现。尽管有待开展更大规模的随机对照研究来比较VATS和RVATS手术的结果,但已发表的研究显示了RVATS手术的非劣效性数据。随着技术的不断进步,如克服触觉反馈缺失等问题,以及未来人工智能(AI)的融入,一旦外科医生克服了最初的学习曲线,机器人平台可能会成为一种具有成本效益的途径。