Robotic assisted lobectomy and lymphadenectomy “different approaches”

Robot-assisted thoracic surgery (RATS) is a relatively new technique for minimally invasive lung lobectomy. During the last decade, different robotic approaches have been described on performing a lung resection ranging from the use of three or four robotic arms, utility incision or CO₂ insufflation, and different port placement. So far, a not-completely portal lobectomy (with utility incision) or completely portal robotic lobectomy (CPRL) is the mostly used robotic approaches to perform lung resection. RATS for lung lobectomy resulted feasible and safe with low rate of conversion, and associated with reduced mortality, shorter hospital stay, and fewer overall complications compare to open surgery. Besides, the 3D vision and the wide range of high-precision movements of the robotic system, even greater than the human wrist, are crucial in performing lymphadenectomy, allowing an excellent hilar and mediastinal lymph node dissection. Thus, RATS allowed an adequate lymphadenectomy with detection of occult lymph node metastatic disease, with significant overall pathological lymph node upstaging and equal oncologic outcomes compare to open radical lymphadenectomy. However, robotic surgery has still some limitations, including increased costs, absence of a tactile feedback, and the need for specialized equipment and training; beside, longer follow-up is still needed to have a correct vision of the long-term outcome.