NEWS ENG: Robotic lung surgery proven the reliability and effectiveness of the surgical robot
The IEO Division of Thoracic Surgery is the first in Italy and among the first in Europe to have reached the milestone of 1,000 robotic lobectomies, a series not yet described as a mono-institutional series in the scientific international literature. The robot intervention was confirmed to be safe both from a surgical and an oncological point of view: in 78% of patients no postoperative complications were found and 92% of treated patients are alive after oncological follow-up. average of 39 months.
“At IEO we started the robotic lung surgery program in 2006 and we were among the first to believe in this approach – comments prof. Lorenzo Spaggiari, Director of the IEO Lung Program and Professor at the University of Milan – In these 16 years, the robotic technology of the da Vinci system, one of the first systems for minimally invasive robot-assisted surgery used in the world, has evolved to the point of fourth technological generation with the da Vinci Xi system which was used in over 70% of the robotic procedures performed in IEO.
We have followed this evolution, investing not only in technology but in time and resources for training and continuous updating of nurses and doctors – continues Spaggiari. We did it for the benefit of patients of today and tomorrow because we do not doubt that the robotic approach is in the future of surgery. The robot will be the instrument of the surgeon of the future, just as the scalpel was until yesterday, and just like the scalpel, the surgeon will continue to control it.
Intuition, creativity, which exists in surgery, and above all empathy are not “technologizable”, therefore the thought function linked to the surgeon’s personality and vision, will not only remain intact but will be amplified as automation processes become more sophisticated. When the surgeon understands the potential of this instrument, a world of possibilities opens up, from which it becomes mentally almost impossible to step back” explains professor Spaggiari.
The da Vinci Xi system consists of three elements: the first is connected to the patient with four robotic arms dedicated to supporting the instruments and the camera; a surgical console where the surgeon manages the instruments and the camera; the viewing section that includes image processing systems together with a touchscreen monitor available to the assistant surgeon and the nursing team, essential for training and tutoring.
The 1,000 robotic lobectomies were performed in IEO on a population of patients with a mean age of 66 years (range: 28-89 years) with a male prevalence (54%). Lobectomies were performed mainly in patients with primary lung tumors (adenocarcinoma being the most frequent histology in over 70% of cases). Pathological staging has shown how the indication of robotic lobectomy mainly finds space in the initial stages (Stages IA / B = 70%, Stage IIA = 3%, Stage IIB = 11%); however, this approach has been used in about 10% of locally advanced stages, highlighting its role in all oncological stages.
The average hospital stay of five days allowed to amortise the costs of use and maintenance of the robot, also underlining how robotic surgery, if performed in high-volume centers, allows a favourable cost-effectiveness ratio.
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