Robotic-assisted thoracoscopic surgery: cost and lymph node dissection

We appreciate the thoughtful and constructive comments by Dr. Turner and Dr. Molena (1). All of your comments were valuable and helpful in improving our paper. We have studied your comments carefully and have made the suggested corrections, which we hope will meet with your approval. Our responses to your comments are below.

• The use of carbon dioxide insufflation allows for more working room, better visualization, and improved mediastinal stability, and this technique is routinely performed in our center;
• Currently in China, robotic-assisted thoracoscopic surgery (RATS) is significantly more costly than video-assisted thoracoscopic surgery (VATS), but as robot technology becomes more popular, the costs are likely to gradually decrease;
• Louie et al. described the dissection of many N1-level lymph nodes (LNs) using RATS, and this report gave surgeons greater confidence to dissect N1-LNs adjacent to the pulmonary artery (2). Cerfolio et al. and Veronesi et al. showed that dissections of LNs using RATS were comparable to thoracotomies (3,4). We found that RATS has the advantage to perform the LN dissection at any angle of the visual field on account of the flexible arms of the robotic system;
• The approach described by Dr. Turner and Dr. Molena is also excellent and appropriate for most patients. Thank you for your suggestions.

Acknowledgements

We would like to acknowledge David Tian, Senior Editor of AME Publishing Company, for editing support.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

1. Turner SR, Molena D. Robotic-assisted left upper lobectomy: facing the challenge head-on. J Thorac Dis 2017;9:2323-4. [Crossref] [PubMed]
2. Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg 2012;93:1598-604; discussion 1604-5. [Crossref] [PubMed]
3. Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg 2011;142:740-6. [Crossref] [PubMed]
4. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer. J Thorac Cardiovasc Surg 2010;140:19-25. [Crossref] [PubMed]