Overview

Robotic thoracic surgery( Robotics Assisted Thoracoscopic Surgery or RATS) is a type of minimally access surgery used in benign and malignant thoracic procedures. Also called robotic-assisted thoracic surgery, it can remove diseased areas and surrounding tissues. In robotic surgery, a surgeon will sit at a console next to the patient in the operating room and control the instruments on the robotic surgical system. The procedure includes the following steps -

- First, a small 3D high-definition camera is placed through one of the cuts (incisions) to provide a view of the inside of the chest cavity.
- Then robotic instruments are placed through the other tiny incisions between the ribs.
- The doctor’s hands entirely control the robotic instruments at the console.
- The surgeon removes tissue through one of the incisions.
- The magnified view and wristed instruments allow the surgeon to make precise, controlled movements to remove tissue without making larger incisions to open up the chest or spread the ribs.

The robotic technique can be used for different types of chest procedures involving the lungs, oesophagus, thymus, and specific cardiac procedures, besides lung cancer surgery.

Conditions Treated Through Robotic Thoracic Surgery

- Lung Cancer
- Esophageal diseases
- Thymoma and Thymic Carcinoma
- Thymectomy for Myasthenia Gravis
- Chest Wall Tumours
- Neurogenic Tumours
- Carcinoid Tumours
- Mediastinal Tumours
- Bullous disease and pneumothorax
- Complicated pleural collection

How is Robotic Surgery Performed?

Robotic surgery is performed in a specially designed robotic surgery OT consisting of a surgeon console with hand and foot controls, a 3-D HD viewer, a movable patient cart with robotic arms, and a vision cart displaying three-dimensional magnified colour images.

The surgeon controls all movements of the robot. The robot cannot act autonomously, so the

surgery is also called robotic-assisted. The surgical field is presented to the surgeon through the 3-D HD vision of the robot. The robot’s “wristed” instruments move in tandem with the surgeon’s hands providing unparalleled dexterity, precision, and control. The patient, asleep under general anaesthesia, is positioned on a movable cart about ten feet from the surgeon's console. The surgeon makes several tiny incisions through which the operation is conducted. Robotic “arms” controlled by the surgeon then pass a camera and surgical instruments into the patient, including the EndoWrist. This instrument can bend and rotate with far greater than the human hand, utilising 7 degrees of freedom and 90 degrees of articulation. The hands of the surgeon move the arms and cameras of the robot. The robot provides the surgeon with the far greater magnification of the surgical field and allows precise movements of the surgical instruments. After the surgery, the tumour and other tissue are removed through one of the incisions

along with the surgical instruments.

Advantages of Robotic Thoracic Surgery

Robotic surgery is a significant advancement for thoracic surgeons operating in a small area

bounded by the rib cage. The surgical robot operates through small incisions. The only tissue cut is the skin since deeper tissues are spread apart gently. The robot rotates around a pivot point near the patient’s ribs, minimising physical pressure on sensitive nerves and tissues. This greatly lessens postoperative pain and speeds recovery.

The surgical robot offers 3-D HD imaging and magnification, scalable motion, and 7 degrees of freedom in manipulating surgical “wrists”, enabling unparalleled surgical accuracy. The robot is, in reality, an extension of the surgeon’s arms and hands, providing him/her with the tools to perform intricate surgical procedures in tight angles and confined spaces.

Benefits for Patients and Risks

The benefits of the robotic system are numerous and include:

- Very Small Incisions. Of the three major surgical approaches thoracic surgeons use today, robotic surgery is the only one in which tiny incisions are exclusively used. This results in less scarring and leads to a faster recovery from surgery.
- Less Blood Loss. A more technically precise surgery means less blood loss and fewer blood transfusions.
- Less Postoperative Pain. The chest wall is a sensitive area where surgery can easily inflame the nerves. The good news is that incisions used in robotic surgery are made in the lower part of the chest where space between the ribs is most significant, thereby greatly lessening post-operative pain.
- Shorter Hospital Stay. Robotic surgery reduces the length of hospital stays. Sometimes, the patient can be discharged 1-2 days after surgery. The results of Robotic Thoracic surgery are as good as open and VATS (Video Assisted Thoracoscopic Surgery) in terms of clearing disease with several advantages in both cancer and non-cancer diseases.
- More Precise Assessment of Involvement and Operative Staging. The robotic system allows for a more thorough dissection of tissues to “stage” or determine the extent of cancer. This information is critical to getting an accurate prognosis and guiding treatment decisions.

All types of surgery carry risks. They may include but are not limited to blood clots, infection, bleeding, abnormal heartbeats, air leakage from your lungs and pain. Robotic thoracic surgery may be associated with longer operative times and a longer time under anaesthesia. If needed, your surgeon may have to convert to a more invasive approach to complete the surgery.

Each person handles surgery differently, and your outcomes may depend on several factors, like your health history, the type of lung cancer, the planned procedure and/or your surgeon’s experience.

- Why Choose NH for Robotic Thoracic Surgery? One of the largest thoracic programmes in India with all ranges of minimal access surgeries, including VATS and RATS.
- Top Rated Thoracic Surgical Team. NH is the only institute in Eastern India to have a team of Qualified Thoracic Surgeons who are Certified and trained in the robotic Thoracic surgical field along with the experience of performing more than a decade of experience performing minimal access surgery.
- Seamless Multidisciplinary Care. The Thoracic Program offers seamless multidisciplinary care to patients. Surgeons work as a team with other specialists, including medical oncologists, radiation oncologists, pulmonologists, radiologists, and pathologists.
- Enhanced Recovery after Surgery (ERAS). NH has a special program for patients designed to enhance recovery after thoracic surgery. This includes a faster recovery, shorter hospital stay, and safer, more effective pain management. Thoracic surgeons, anesthesiologists, hospitalists, and nurses use the latest evidence-based protocols to provide state-of-the-art innovative peri-operative care.
- Dedicated Nursing Team. NH has a dedicated robotic thoracic surgery nursing team skilled in all key aspects of robotic procedures.
- Precision Medicine. NH offers every patient who has undergone surgery a novel approach, differentiating ultra-low-risk patients who do not need additional treatment from higher-risk patients who might benefit from additional therapy.

What to expect?

- Your doctor will discuss what you need to do to prepare for surgery.
- Your surgery will begin with you being placed under general anaesthesia.
- Once asleep, a breathing tube is placed into your airway to allow each lung to be separately
- inflated during surgery. You are then positioned on your side.
- The surgeon will typically make four minor cuts (incisions) between your ribs so they can access your thoracic (chest) area using the robot.
- The surgical assistant will place the instruments and cameras attached to the “arms” of the robot into the incisions.
- The surgeon sits at a control console nearby where they can see magnified, clear images of the
- surgical area.
- The robot responds in real-time to the surgeon’s hand movements as the surgeon removes the diseased part of the lung and possibly lymph nodes.
- At the end of the surgery, the surgeon will insert a chest tube through one of the small incisions to drain fluid or air leaking into the chest cavity and help your lungs re-inflate. Your care team will remove this tube as you recover.
- Minimally invasive surgery often means a shorter recovery time, and patients are usually discharged from the hospital sooner.
- Follow any post-operative instructions from your doctor.
- It is important to give yourself time to rest when you go home. Gradually you will get stronger and feel like yourself.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

In conclusion, robotic thoracic surgery has revolutionised the field of thoracic procedures, offering unparalleled precision, smaller incisions, reduced pain, and faster recovery times. With its remarkable advancements, patients can benefit from safer and more effective treatment options.

FAQs

Q. What are the advantages of Robotic Thoracic Surgery? A. Robotic surgery is a significant advancement for thoracic surgeons operating in a small area bounded by the rib cage. The surgical robot operates through small incisions. The only tissue cut is the skin since deeper tissues are spread apart gently. The robot rotates around a pivot point near the patient’s ribs, minimising physical pressure on sensitive nerves and tissues. This greatly lessens postoperative pain and speeds recovery.

Q. What are the conditions treated through Robotic Thoracic Surgery A. Some of the conditions treated through Robotic Thoracic Surgery are:

- Lung Cancer
- Esophageal diseases
- Thymoma and Thymic Carcinoma
- Thymectomy for Myasthenia Gravis
- Chest Wall Tumours
- Neurogenic Tumours
- Carcinoid Tumours
- Mediastinal Tumours
- Bullous disease and pneumothorax
- Complicated pleural collection

Q. What are the benefits for Patients undergoing Robotic Thoracic Surgery? A. Small incisions, less blood loss, less post operative care and Shorter hospital stay are some of the benefits of this procedure.