Robotics in pulmonology and thoracic surgery: what, why and when?

INTRODUCTION: Robot-assisted surgery emerged and evolved in order to increase the surgical precision and due to the need to overcome the drawbacks of conventional minimally invasive surgery. In thoracic surgery the first reported use of a robotic device was in a series of 12 patients with different lung pathologies with the assistance of the DaVinci Robotic Surgical System in 2002. The DaVinci system has been used for various procedures in the field of thoracic surgery since then. While its advantages for the resection of early stage thymoma have been well documented, its role in the treatment of lung cancer and other pathologies is still under investigation. EVIDENCE ACQUISITION: A systematic literature search was performed on the following medical databases: Medline, EMBASE and Cochrane Library. The search was performed in June 2016 and was limited to material published since the first report of a robotic system for a surgical procedure in 1985. EVIDENCE SYNTHESIS: The results for various thoracic surgical procedures were analyzed with focus on the benefits and limitations of the robotic system compared to open and thoracoscopic or video-assisted techniques. CONCLUSIONS: Although numerous studies have shown the feasibility and safety of robotic surgery for various procedures, they were not able to show superior postoperative outcomes in terms of morbidity and mortality in exchange for the higher costs of robotic surgery compared to conventional video-assisted thoracic surgery (VATS), except for early-stage thymoma resection. Therefore, randomized control trials comparing robotic particularly with VATS, but also with open procedures are required to further evaluate this crucial topic.