Robotic assisted lung resection needs further evidence

Since robotic assisted thoracic surgery (RATS) for lung resection using the “Da Vinci robotic system” has been introduced into the clinical practice of thoracic surgery by Dr. Melfi from Pisa in 2001 and published in 2002 (1), several steps ahead have been done, and the procedure has become more commonly used worldwide. Nevertheless in their article Bao and colleagues conclude “that robotics for lung cancer seems to have higher costs and longer operative time without superior advantage in morbidity rates and oncologic efficiency” (2). In few words, the authors add questions to the already known controversy about the application of RATS for lung resection, and confirm that the use of robotics is not yet based on good evidence of any effect on survival when compared with open surgery or standard video assisted thoracic surgery (VATS). In particular, the observations of Bao et al. (2) are in contrast with those who reported that robotics surgery has several advantages. The proponents of RATS have in fact reasoned that more intuitive movements, greater flexibility and high-definition three-dimensional vision render surgery easier for the surgeon, with shorter learning curve than VATS. Furthermore the proponents affirm that robot-assisted approaches to lung cancer resection and lymph node dissection appear to offer comparable radicality and safety to VATS and open surgery (3-5). Nevertheless it is wise here to remember that many of the proponents of RATS declare relationships with the robotic industries (6).