Iftikhar Muhammad Khubaib, Iftikhar Qurat Ul Ain
Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan.
Gen Thorac Cardiovasc Surg. 2025 May 19. doi: 10.1007/s11748-025-02158-7.
In response to the article by Fukui et al. on robotic-assisted thoracic surgery (RATS) for neurogenic tumors at the thoracic apex, we offer a critical appraisal emphasizing the risks and overlooked safeguards associated with this approach. While this study highlights the feasibility of preoperative imaging in surgical selection, it reports notably high rates of postoperative neurological complications, including persistent deficits. We argue that advanced imaging modalities, such as three-dimensional CT and omission of intraoperative neuromonitoring (IONM), merit deeper scrutiny, especially given the proximity to critical neural structures. Additionally, we question the ethical implications of applying aggressive surgical techniques to benign and often asymptomatic lesions. We advocate for a more nuanced, patient-centered approach that balances technical ambition with functional preservation. Our commentary underscores the need for introspective surgical decision-making in the era of robotics.
针对福井等人关于机器人辅助胸外科手术（RATS）治疗胸段神经源性肿瘤的文章，我们进行了批判性评估，强调了这种手术方式所涉及的风险以及被忽视的安全保障措施。虽然该研究突出了术前成像在手术选择中的可行性，但报告显示术后神经并发症发生率极高，包括持续性神经功能缺损。我们认为，鉴于手术部位临近关键神经结构，像三维CT等先进成像模式以及术中神经监测（IONM）的缺失值得深入审视。此外，对于将激进的手术技术应用于良性且通常无症状的病变的伦理问题，我们也提出质疑。我们主张采取一种更细致入微、以患者为中心的方法，在技术追求与功能保留之间取得平衡。我们的评论强调了在机器人手术时代进行深入反思性手术决策的必要性。
