In thoracic surgery, especially in lung cancer and mediastinal masses, robotic surgery is increasingly used in the world, especially in the USA and Europe, due to its apparent technical superiority over Video Assisted surgery (VATS) and open surgeries.
da Vinci Robotic Surgery
The surgeon operates through small incisions with the da Vinci Robotic Surgery system. In robotic surgery, we operate through small tubes called 'ports' placed in small incisions, as in thoracoscopic (VATS) and laparoscopic surgery. One of the arms of the robot holds the camera; the other has surgical instruments. The surgeon performs the operation sitting at a computer console. The console operates by controlling the arms. The da Vinci robot's surgical instruments simultaneously execute the surgeon's commands at the console.
Figure 1: The surgeon operates while sitting at a computer console. In an operation, a surgeon and a nurse are at the patient's side and help the surgeon at the console.
The surgeon makes small, precise movements with his hands, wrists, and fingers and converts these movements into real-time micro-movements. A surgeon standing at the patient's bedside during the operation helps the surgeon at the console. Like our eyes, the procedure is under a 3D image with a sense of depth on the console. The operation area is enlarged 10-12 times with cameras.
By magnifying the anatomical structures in deep and narrow areas with the camera, injuries that may occur during surgery are minimized. The surgeon gives commands using the camera and other tools with the help of his hands and feet.
Thanks to the system called 'endowrist,' these tooltips can rotate 540 degrees around their axis and imitate the wrist movements of the human hand. In robotic surgery, the possible hand tremor of the surgeon during the operation is not transmitted to the instruments in any way.
Figure 1. A) View of posterior incisions for right lower lobe common basal segmentectomy (B) Front view of incisions (C) View of robotic operation and service port, C) Port entrances
Is Robotic Surgery for Every Patient?
Robotic surgery may not be an option for every patient. Robotic surgery is more successful than Thoracoscopic (VATS) surgeries, especially in the following thoracic surgical diseases.
- Early-stage lung cancer
- Lung resections
- Tumors and cysts of the mediastinal region
- Thymoma
- Neurogenic tumors
- Teratoma
- Mediastinal Cysts
- Diaphragmatic diseases
- Removing lymph nodes in lung cancers provides an oncological advantage of robotic surgery over VATS, as we can remove more lymph nodes in robotic surgery.
Da Vinci Robotic Surgery Provides Many Advantages
- Since lymph node invasion is common in lung cancers, it provides an oncological advantage over video-assisted surgeries.
- Less complication rate
- Less blood loss
- Less post-operative and chronic pain
- Fast recovery
- An earlier discharge
- Minor incision scars and aesthetic appearance
Figure 2: Traces of incisions after robotic surgery in a patient who underwent left lower lobe common basal segmentectomy.
Are There Risks of Robotic Surgery?
Similar complications in traditional methods are at lower rates in robotic surgery. Robot equipment provides minor damage to the surrounding tissues in the chest cavity and reduces the complication rate.
After da Vinci Robotic Surgery
Frequently Asked Questions About da Vinci Robotic Surgery
- Surgery with a single port VATS
- Surgery with VATS
- robotic surgery
VATS, classically, is performed from 3 incisions (ports). Later, we started to perform major surgeries such as lung cancer from 2 incisions comfortably and safely, which are still the two most preferred ports. One port camera is for surgical instruments from the other second port. But recently, we have started to do this with Single Port VATS, that is, from a single entry. The camera and surgical instruments are inserted through a single incision, and the operation is performed. Robotic surgery requires at least three ports.
Imagine you are working with flat bars in a closed area with VATS. Still, in Robotic surgery, the Surgeon, Like our eyes, the procedure under a 3D image with a sense of depth on the console. The operation area is enlarged 10-12 times with cameras.
By magnifying the anatomical structures in deep and narrow areas with the camera, injuries that may occur during surgery are minimized. The surgeon gives commands using the camera and other tools with the help of his hands and feet.
Thanks to the system called 'endowrist,' these tooltips can rotate 540 degrees around their axis and imitate the wrist movements of the human hand. In robotic surgery, the possible hand tremor of the surgeon during the operation is not transmitted to the instruments in any way.
Since lymph node invasion is common in lung cancers, it provides an oncological advantage over video-assisted surgeries.
The surgeon performs the operation sitting at a computer console. The console operates by controlling the arms. The da Vinci robot's surgical instruments simultaneously execute the surgeon's commands at the console. The surgeon makes small, precise movements with his hands, wrists, and fingers and converts these movements into real-time micro-movements.
- The patient satisfaction rate is high, and it is a highly reliable method.
- Compared to open surgery, the incisions are relatively small and have the advantage of a better cosmetic appearance.
- It is a much less painful and more comfortable surgical method than open surgery. Since there is less pain, patients use fewer painkillers.
- Fewer cardiac problems (such as atrial fibrillation)
- It is more comfortable in terms of respiratory functions
- Fewer complications (such as pneumonia)
- The immune system is less affected
- The length of stay in the hospital is short, and a rapid return to everyday life is achieved.
- VATS provides comfort for the patients not only after the operation in the hospital but also in the post-discharge period.
- Less chronic pain.
- Better and more comfortable in terms of respiratory function.
- If the patient needs chemotherapy/radiotherapy, the recovery will be faster.