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Eur J Cardiothorac Surg 2004;25:844-851
© 2004 Elsevier Science NL

First experiences with the da Vinci^TM operating robot in thoracic surgery

Department of General and Transplant Surgery, University Hospital Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria

Received 9 October 2003; received in revised form 9 January 2004; accepted 4 February 2004.

^* Corresponding author. Address: Department of General and Transplant Surgery, University Hospital Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Tel.: +43-512-504-2580; fax: +43-512-504-675-948
e-mail: thomas.schmid{at}uibk.ac.at

Objectives: The da Vinci^TM surgical robotic system was purchased at our institution in June 2001. The aim of this trial was to evaluate the applicability of the da Vinci^TM operation robot for general thoracic procedures. Methods: The da Vinci^TM surgical system consists of a console connected to a surgical arm cart, a manipulator unit with two instrument arms and a central arm to guide the endoscope. The surgical instruments are introduced via special ports and attached to the arms of the robot. The surgeon, sitting at the console, triggers highly sensitive motion sensors that transfer the surgeon's movements to the tip of the instruments. The so-called ‘EndoWrist^TM technology’ offers seven degrees of movement, thus exceeding the capacity of a surgeon's hand in open surgery. We evaluated the role of the robot for several thoracic procedures such as thymectomies, fundoplications, esophageal dissections, resection of mediastinal masses and a pulmonary lobectomy. Results: A total of 10 thymectomies, 16 fundoplications, 4 esophageal dissections, 5 extirpations of benign mediastinal masses and 1 right lower lobectomy was performed with the robot. One resection of a paravertebral neurogenic tumor had to be converted due to surgical problems. A lesion to a left recurrent laryngeal nerve caused transient hoarseness after the extirpation of an ectopic parathyroid in the aortopulmonary window in one patient. The postoperative courses were uneventful and patients were discharged between postoperative days 3 and 8 (with the exception of patients who underwent dissection for esophageal cancer and the patient with conversion to an open access). Conclusions: Advanced general thoracic procedures can be performed safely with the da Vinci^TM robot allowing precise dissection in remote and difficult-to-reach areas. This benefit becomes evident most elegantly in thymectomies, which at our institution have become a routine procedure with the robot. The rigid anatomy of the chest seems to be an ideal condition for robotic surgery. A major limitation for robotic surgery is the lack of more appropriate instruments. This disadvantage becomes most evident in pulmonary lobectomies.

Key Words: Thoracic surgery • Robotics • da Vinci robotic system • Video-assisted thoracoscopic surgery • Fundoplication

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