What to Know About Robotic Surgery for Lung Cancer

Robotic lung surgery was introduced in 2002. When it’s used to treat lung cancer, it’s called robotic assisted thoracic surgery (RATS).

Robotic lung surgery involves a cart with three or four robotic arms and a console that allows the surgeon to manipulate the arms.

Sitting at the console, the surgeon looks down at a high-resolution, three-dimensional magnified image. They then manipulate the arm and camera with simple hand movements. A computer translates these movements to the tools in the operative field.

Robotic surgery for lung cancer is used primarily for stage 1 or 2 non-small cell lung cancer (NSCLC).

With stage 1 or 2 NSCLC, the lobe of the lung that contains the tumor can usually be removed robotically. This procedure is called a lobectomy. If only a segment of a lobe needs to be removed, a wedge resection is performed.

Robotic surgery can also be used after neoadjuvant therapy if there’s any remaining tumor to be removed.

With later stages of NSCLC, the cancer has usually spread beyond the lungs. This rules out robotic surgery. Chemotherapy and radiation therapy are better options to treat more advanced cancer.

If the entire lung must be removed, a surgeon will perform a pneumonectomy. This procedure can’t be performed with robotic lung surgery. Instead, a large incision is needed to remove the lung.

Before minimally invasive surgery was developed, all surgeries were open procedures.

These surgeries required an incision large enough to accommodate all the necessary instruments and to provide a good view of the area being operated on. Additionally, either the ribs had to be removed or separated or the breastbone (sternum) had to be cut open to perform the surgery.

Developed in the 1990s, video-assisted thoracic surgery (VATS) is the type of minimally invasive surgery used on organs in the chest, including the lungs.

Surgical instruments and a scope with an attached camera are inserted into the chest cavity through small incisions. Watching video images from the camera on a monitor, a surgeon uses the instruments to perform the procedure.

VATS works well, but it can be difficult to perform. This is because the rigid tools have limited mobility. Plus, the surgeon must look up and away from the tools to view the surgical field on a two-dimensional monitor.

Robotic surgery for lung cancer overcomes the limitations of VATS in two main ways, which we’ll discuss in more detail below.

The robotic arm gives better mobility

“Robotic” refers to the arm that’s used to manipulate the tools during surgery, not an actual robot. It’s a mechanical arm with tiny tools attached to one end. Three or four of these arms make up one robotic unit. To perform an operation, the surgeon directs the movement of these arms from the console.

Since the robotic arm is articulated like your wrist, it can move like a human hand. This means the surgeon can control the arm using hand movements like those used for open surgery. The result is more precise and accurate surgery.

The upgraded camera gives a better view

An upgraded camera gives a high definition, magnified, three-dimensional view inside the chest. It’s very similar to the view in open surgery.

The main benefit of minimally invasive procedure is the small size of the incisions. While open surgery requires an incision as large as 7 inches in length, incisions for minimally invasive procedures are usually only 1 to 2 cm long.

Other benefits of minimally invasive surgery (robotic surgery for lung cancer and VATS) when compared to open surgery include:

• Less pain. Less muscle and tissue is cut when making small incisions so there’s less pain.
• Better healing. Small incisions form less scar tissue than larger incisions when they heal.
• Less blood loss. Smaller incisions and less tissue damage result in less bleeding during surgery.
• Surgery takes less time. Less time in the operating room is associated with fewer complications and faster healing.
• Shorter postoperative hospital stay. Smaller incisions heal more quickly than larger ones.
• Reduced recovery time. Reducing injury to muscles used for breathing minimizes the loss of lung function so patients are back on their feet sooner.

Robotic surgery for lung cancer also has advantages over VATS including:

• Greater precision: The articulated robotic arm has a greater range of motion and better ergonomics than rigid tools which allows the surgeon to use precise movements.
• Better view: The camera provides a high-definition, three-dimensional magnified view of the chest cavity.
• Reduces tremors: The robotic arm eliminates any shakiness a surgeon might have during the procedure.
• More complex surgeries can be performed: Increased mobility and a better view make complex surgeries easier to perform.

The long- and short-term outcomes of robotic surgery for lung cancer are similar to VATS. Both of these minimally invasive surgeries tend to have better outcomes and fewer complications than open surgery.

Prior to surgery you’ll likely undergo pulmonary function tests to ensure you can tolerate the procedure.

Robotic surgery for lung cancer is performed under general anesthesia. Once the anesthesia starts to work, a special breathing tube is inserted into your airway. This tube allows your lungs to be inflated and deflated separately.

You’ll be moved onto your side. The surgeon will then make 3 or 4 small incisions through your chest wall. The camera and articulated tools that are attached to the robotic arm will be inserted into these incisions.

Sitting at a console near you in the operating room, your surgeon will look at the three-dimensional image produced by the camera and will move the robotic arm to perform the procedure.

Cancerous lung tissue is cut off and removed through one of the incisions. Usually, some of the lymph nodes around the lung are also removed to see if the cancer has progressed beyond the lungs.

Once the surgeon is confident that all the cancer has been removed, the instruments will be retracted and the incisions will be closed.

A chest tube is usually inserted into one of the incisions to collect fluid and air leaving the chest and to help the lung re-inflate after surgery.

You’ll typically remain in the hospital for 2 to 4 days where you’ll begin your recovery. You may have some physical therapy to help you adjust to breathing with less lung tissue.

Although surgery for lung cancer is a minimally invasive procedure, it’s still a major surgery involving a major organ. As your body heals and recovers, you may have some symptoms like:

• fatigue
• shortness of breath
• a sore throat from the breathing tube
• some pain

There are precautions you can take to adjust to breathing with less lung tissue and to shorten your recovery time. To help your body heal, try to do the following within the first 6 to 8 weeks after your surgery:

• Rest often and get enough sleep every night.
• Exercise regularly according to your physical therapists’ recommendations.
• Quit smoking and avoid secondhand smoke.
• Eat a nutritious balanced diet.
• Participate in pulmonary rehabilitation where you’ll learn breathing and relaxation techniques and upper body and arm strengthening exercises.
• Take all medications as prescribed.
• Go to all scheduled follow up appointments and follow your doctor’s instructions.

Robotic lung surgery is a minimally invasive surgical technique that can be used to remove cancerous tissue from the lungs. With this type of surgery, a surgeon uses a computer to manipulate small tools attached to a robotic arm that can perform precise movements inside the chest cavity.

With stage 1 or 2 NSCLC, a doctor may suggest robotic assisted thoracic surgery. This allows the surgeon to remove a lobe or a section of the lung’s lobe through small incisions in the chest. The small incisions allow for better healing, less pain, and reduced recovery time.