We are grateful for the reviewers’ comments on our manuscript entitled “Robotic-assisted right upper lobectomy” (1). Robot-assisted thoracic surgery (RATS) has been performed for several years with the first robotic lung resections described in 2002 by Melfi et al. (2). An analysis of the U.S. National Cancer Data Base found that the percentage of robotic lobectomies increased from 3% in 2010 up to 9% in 2012 (3). Although the number of robotic lung resections performed are increasing, the primary factor that continues to impede widespread use of the robotic technique is the higher overall cost of RATS relative to the cost of video-assisted thoracic surgery (VATS) approaches (4-7). We believe that the cost of robotic surgery will decrease as the instrumentation develops and when the pertinent patent becomes overdue.
Currently, we need randomized controlled studies that compare VATS and robotic assisted thoracoscopic surgery to determine which procedure should be used to remove various stage tumors. We believe that RATS lobectomy should be taught to all thoracic surgery residents. Access to an animal lab to train surgeons in RATS and VATS is critical for training. After training, we recommend that appropriate measures be taken to prevent and/or properly manage intraoperative complications with the robot.
We believe that new developments, such as improved instruments, tactile feedback, and “enhanced” reality, in RATS will reduce the cost of robotic surgery and will allow for more and improved widespread use of this advanced technology.
We would like to acknowledge David Tian, Senior Editor of AME Publishing Company, for editing support.
Conflicts of Interest: The authors have no conflicts of interest to declare.
- Migliore M. Is robotic surgery for NSCLC innovative enough? J Thorac Dis 2017;9:2326-7. [Crossref] [PubMed]
- Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 2002;21:864-8. [Crossref] [PubMed]
- Rajaram R, Mohanty S, Bentrem DJ, et al. Nationwide Assessment of Robotic Lobectomy for Non-Small Cell Lung Cancer. Ann Thorac Surg 2017;103:1092-100. [Crossref] [PubMed]
- Park BJ, Flores RM. Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin 2008;18:297-300. vii. [Crossref] [PubMed]
- Swanson SJ, Miller DL, McKenna RJ Jr, et al. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg 2014;147:929-37. [Crossref] [PubMed]
- Paul S, Jalbert J, Isaacs AJ, et al. Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy. Chest 2014;146:1505-12. [Crossref] [PubMed]
- Deen SA, Wilson JL, Wilshire CL, 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;97:1000-7. [Crossref] [PubMed]