In the last two decades, robotic-assisted thoracoscopic surgery (RATS) has gained popularity as a minimally invasive surgical (MIS) alternative to multi- and uniportal video-assisted thoracoscopic surgery (VATS). With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception, hand-eye coordination, and freedom of motion of the instruments. Previous studies have shown that a robotic approach for operable lung cancer has treatment outcomes comparable to other MIS techniques such as multi-and uniportal VATS, but with less blood loss, a lower conversion rate to open surgery, better lymph node dissection rates, and improved ergonomics for the surgeon. The thoracic surgeon of the future is expected to perform more complex procedures. More patients will enter a multimodal treatment scheme making surgery more difficult due to severe inflammation. Furthermore, due to lung cancer screening programs, the number of patients presenting with operable smaller lung nodules in the periphery of the lung will increase. This, combined with the fact that segmentectomy is becoming an increasingly popular treatment for small peripheral lung lesions, indicates that the future thoracic surgeons need to have profound knowledge of segmental resections. New imaging techniques will help them to locate these lesions and to achieve a complete oncologic resection. Current robotic techniques exist to help the thoracic surgeon overcome these challenges. In this review, an update of the latest MIS approaches and nodule detection techniques will be given.
在过去二十年中，机器人辅助胸腔镜手术（RATS）作为多孔及单孔电视辅助胸腔镜手术（VATS）的微创替代方案日益普及。该技术使外科医生能够规避传统微创手术的固有缺陷，例如深度感知减弱、手眼协调性不足以及器械活动自由度受限等问题。既往研究表明，针对可手术肺癌的机器人手术在治疗效果上与多孔及单孔VATS等其他微创技术相当，且具有术中失血量更少、中转开胸率更低、淋巴结清扫更彻底以及更符合人体工程学设计等优势。未来胸外科医生将面临更复杂的手术挑战：更多患者将接受多模式治疗方案，而严重炎症反应会增加手术难度；同时肺癌筛查项目的推广将导致肺外周可手术小结节患者数量显著增加。结合肺段切除术日益成为外周小肺癌主流治疗方式的趋势，未来胸外科医生必须精通肺段解剖与切除技术。新兴影像技术将助力术者精准定位病灶并实现肿瘤学意义上的完整切除。现有机器人技术已为胸外科医生应对这些挑战提供了有效支持。本综述将系统阐述微创手术最新进展与结节定位技术的研究现状。
Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand?
肿瘤(癌症)患者之家