Advanced resections in minimally invasive surgery: robotic pneumonectomy

Radical surgery including standard anatomical resections (segmentectomy, lobectomy and pneumonectomy) remains the standard treatment for lung cancer. These procedures are historically performed by an open approach, but in the last years minimally invasive approaches [video-thoracoscopic thoracic surgery (VATS), and robotic-assisted surgery] have gained popularity and acceptance in the thoracic surgical domain. These minimally invasive approaches have shown an increased benefit for patients because they are associated with minor morbidity, and less postoperative hospital stay compared to a conventional thoracotomy. Robotic thoracic surgery is increasing in the last decade due to its advantages compared to VATS: a best vision, an increased degree of freedom in movements, and absence of the tremor. The robotic technique was largely used for performing lobectomy and segmentectomy in early-stage lung cancer; however, few reports described its use in performing pneumonectomy. In this article we describe indications for robotic pneumonectomy, the robotic set up, the surgical technique, and we discuss the benefit, the disadvantages of this minimally invasive approach.