6 Years Experience with the Da Vinci Robotic System in Thoracic Surgery: A Single Center Report

B. Hoksch, E. Hofmann, A. Rusu, R. A. Schmid

Introduction

One of the most important technical developments of minimally invasive thoracic surgery in recent times is the robotic-assisted operative procedure. The benefits of the robotic-assisted surgery in comparison to the video-assisted surgery are:

  • A: translation of hand movements into micro-movements and elimination of hand tremor high instrument mobility at distal articulations (“wrists”) (Fig. 1)

  • B: availability of high definition 3D-imaging (Fig. 2 and 3)

  • C: improvement of ergonomic conditions for the surgeon (Fig. 4)

Robotic-assisted technology has been available now for more than 15 years and the acceptance of robotic-assisted operations with the Da Vinci Robotic System in thoracic surgery is growing rapidly.

Figure 1: Translation of hand movements into micro-movements and elimination of hand tremor high instrument mobility at distal articulations (“wrists”)
Figures 2 and 3: Availability of high definition 3D-imaging
Figure 4: Improvement of ergonomic conditions for the surgeon

Methods and Patients

The Da Vinci robotic system became available in our division in June 2007. After a period of training we used the robotic system to treat a total of 65 patients with various thoracic diseases. Surgical procedures were thymectomy (n=34), lobectomy (n=9), lymph-node-dissection (n=5), resection of neurinoma and bronchogenic or pericardial cyst (n=17).

Figure 5: Position of a patient for thymectomy. Arrows = side of trocar incisions
Figures 6 and 7: The position of the crew and the surgeon in the OR
Figure 8: The Da Vinci System in action

Results

Operative mortality was 0 %, with no in-hospital or perioperative deaths. The median length of stay was 4.2 days (range, 1-44 days). Two patients (3.1 %) experienced a relevant postoperative complication: One phrenic nerve injury after lobectomy with mediastinal lymph-node dissection, and one chylothorax after paraesophageal lymph-node dissection.

Conclusion

Robotic assistance for thoracic surgery is feasible and safe. The future directions for study of the robotic-assisted technology in thoracic surgery include further refinement of the technique and the validation of the adequacy of the oncologic results.

Perspective

The University Hospital Bern opened the first European center for robotic-assisted and minimally invasive thoracic surgery to ensure a close cooperation of the most experienced thoracic surgeons in Europe.