THORACIC SURGERY (see Chapter
49
)
Background
Thoracic surgery has incorporated video assistance thoracoscopy
(VATS) as a standard of care when it is practical. A large thoracotomy incision
may still be required for a complete pneumonectomy, although the thoracotomy incision
increases stress and morbidity. The use of thoracic epidural analgesia is the standard
of care for such
large thoracic incisions. Robotic assistance for thoracic surgery may provide better
patient outcomes, but studies are needed to prove their potential benefit. Selection
criteria for performing lung tumor resection using robotic assistance include lung
lesions smaller than 5 cm in diameter, stage I status for primary lung carcinoma,
no chest wall involvement, absence of pleural adhesions, and clearly distinguishable
interlobar fissures. The da Vinci Robotic Surgical System was the first telemanipulator
system used.[60]
For this procedure, tactile sensation
is minimal, and it is often difficult to feel pulmonary nodules that are not visible
on the surface. This drawback may require making a port large enough for finger
insertion to palpate the tumor.
