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Lung Resection

Procedure overview

Lung surgery is done mainly to remove cancer.  There are different types of lung surgeries each for different locations of disease, and stage of disease.

Lobectomies, segmental or wedge resections are the most common types of minimally invasive lung surgery performed by thoracic surgeons. A lobectomy is the removal of a lobe of the lung that has the tumour. A segmental or wedge resection involved the removal of a part of a lung lobe with the tumour with a margin of healthy lung tissue. These surgeries may be offered for very early stage non–small cell lung cancer to preserve as much lung function as possible. They may also be done in people with more advanced non–small cell lung cancer who don’t have enough lung function to have more of the lung removed. [1]

Minimally invasive thoracic surgery is a way of performing surgery in the chest through small incisions, without making large cuts or incisions in the body, and does not require spreading apart of the ribs. Surgeons use a camera and instruments to get to the lung through small incisions in between the ribs. There are two different options available for minimally invasive thoracic surgery; video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgery.

thoracic-surgery
Figure 1. Open vs Robotic, Port Placement for Prostate Surgery

VATS is performed similar to standard laparoscopic surgery while in robotic-assisted surgery, a surgeon will sit at a console next to the patient in the operating room and control wristed instruments instruments, including a 3D HD camera, on the robotic surgical system. Learn more about what robotic assisted surgery is and how surgeons use the technology here.

More information about minimally invasive robotic assisted lung surgery from the American Lung Association can be found here.

Potential Benefits​

Reported benefits of robot assisted lung resection include:

  • Patients may experience fewer complications after surgery, though sometimes a similar amount, compared to patients who had open surgery.[2-6]
  • Patients may experience similar complication rates compared to patients who had video-assisted thoracic surgery.[2],[6-14]
  • Patients may stay in the hospital for a shorter amount of time, though sometimes similar, than patients who had open[2-4],[6][15-20] or video-assisted thoracic surgery.[2],[6-16],[18-27]
  • Surgeons may be as likely, or possibly less likely, to switch to open surgery compared to video-assisted thoracic surgery.[7-9],[11-13][19]

Additional Patient Resources

Visit the the Canadian Cancer Society website for more informational about the disease, diagnosis, treatment options and support available.

Community Groups

Educational Videos

Understanding Minimally Invasive Robot Assisted Lung Surgery (American Lung Association)

Thoracic surgeon Dr. Wael Hanna of St Josephs Health Care in Hamilton and his patient discuss using robot assisted surgery to treat cancer 

Thoracic surgeon Dr. Wael Hanna of St Josephs Health Care in Hamilton and his patient discuss using robot assisted surgery to treat cancer 

Risks & Considerations

Not everyone is a candidate for robotic assisted procedures, and other treatment options may be available and appropriate. Only a doctor can determine whether robotic assisted surgery is appropriate for a patient’s situation. Surgery of any form contains risks and it is important to discuss risks with your provider. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Patients have also developed support areas where they are able to speak with each other about the surgery, their experiences, and any issues that they have faced during their treatment. To learn more check out the additional resources above or visit the community section of this website.

[1] cancer.ca

[2] Kent, M., T. Wang, et al., Open, Video-Assisted Thoracic Surgery, and Robotic Lobectomy: Review of a National Database. Ann Thorac Surg, 2014.

[3]Veronesi, G.G., P. Maisonneuve, et al., Four-arm robotic lobectomy for the treatment of early-stage lung cancer. Journal of Thoracic and Cardiovascular Surgery, 2010. 140(1): p. 19-25.

[3] Oh, D.S., I. Cho, et al., Early adoption of robotic pulmonary lobectomy: feasibility and initial outcomes. Am Surg, 2013. 79(10): p. 1075-80.

[4] Zhang, L. and S. Gao, Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer: a system review and meta-analysis. Int J Clin Exp Med 2015. 8(10): p. 17804-17810

[5] Deen, S.A., J.L. Wilson, et al., Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches. Ann Thorac Surg, 2014.

[6] Augustin, F., J. Bodner, et al., Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting. Langenbecks Arch Surg, 2013.

[7] Jang, H.J.L., H. S.; Park, S. Y.; Zo, J. I., Comparison of the early robot-assisted lobectomy experience to video-assisted thoracic surgery lobectomy for lung cancer: A single-institution case series matching study. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2011. 6(5): p. 305-310.

[8] Mahieu, J., P. Rinieri, et al., Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety? Thoracic and Cardiovascular Surgeon, 2015.

[9] Paul, S., J. Jalbert, et al., Comparative Effectiveness of Robotic-Assisted vs. Thoracoscopic Lobectomy. Chest, 2014. 146(6): p. 1505-12

[10] Liang, H., W. Liang, et al., Robotic Versus Video-assisted Lobectomy/Segmentectomy for Lung Cancer: A Meta-analysis. Ann Surg., 2017 Jun 16 [Epub ahead of print]

[11] Wei, S., M. Chen, et al., Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis. World J Surg Oncol., 2017. 15(1):98

[12] Yu, Z., Q. Xie, et al., Perioperative outcomes of robotic surgery for the treatment of lung cancer compared to a conventional video-assisted thoracoscopic surgery (VATS) technique. Oncotarget., 2017. 8(53): p. 91076-91084

[13] Swanson, S.J., D.L. Miller, et al., Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: Results from a multihospital database (Premier). Journal of Thoracic and Cardiovascular Surgery, 2013.
[14] Adams, R.D., W.D. Bolton, et al., Initial Multicenter Community Robotic Lobectomy Experience: Comparisons to a National Database. Ann Thorac Surg, 2014.

[15] Farivar, A.S., R.J. Cerfolio, et al., Comparing Robotic Lung Resection With Thoracotomy and Video-Assisted Thoracoscopic Surgery Cases Entered Into The Society of Thoracic Surgeons Database. Innovations (Phila), 2014. 9(1): p. 10-5.

[16] Cerfolio, R.J., A.S. Bryant, et al., Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. Journal of Thoracic and Cardiovascular Surgery, 2011.

[17] Rajaram, R., S. Mohanty, et al., Nationwide Assessment of Robotic Lobectomy for Non-Small Cell Lung Cancer. Ann Thorac Surg, 2017. 103(4): p. 1092-1100

[18] Yang, C-F.J., Z. Sun, et al., Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base. Ann Thorac Surg, 2016. 101(3): p. 1037–42

[19] Agzarian, J., C. Fahim, et al. The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review. Semin Thorac Cardiovasc Surg,  2016. 28(1): p. 182-92

[20] Bodner, J., T. Schmid, et al., Minimally invasive approaches for lung lobectomy – From VATS to robotic and back! European Surgery – Acta Chirurgica Austriaca, 2011. 43(4): p. 224-228.

[21] Lee, B.E., R.J. Korst, et al., Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages? J Thorac Cardiovasc Surg, 2013.

[22] Lee, B.E., M. Shapiro, et al., Nodal Upstaging in Robotic and Video Assisted Thoracic Surgery Lobectomy for Clinical N0 LungCancer. Annals of Thoracic Surgery, 2015.

[23] Louie, B.E.F., A. S.; Aye, R. W.; Vallieres, E., Early Experience With Robotic Lung Resection Results in Similar Operative Outcomes and Morbidity When Compared With Matched Video-Assisted Thoracoscopic Surgery Cases. Annals of Thoracic Surgery, 2012.

[24] Spillane, J. and P. Brooks, Developing a robotic program in thoracic surgery at Cape Cod Hospital. Journal of Robotic Surgery, 2014: p. 1-8.

[25] Emmert, A., C. Straube, et al., Robotic versus thoracoscopic lung resection: A systematic review and meta-analysis. Medicine, 2017. 96(35):e7633

[26] Louie, B.E., J. Wilson, et al., Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg., 2016. 102(3): p. 917-924

[27] Lee, H.S.J., H. J., Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg, 2012. 24(2): p. 131-41.