Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. The purpose of this study was to develop a technique to perform thoracoscopic lung resection using a telemanipulation system. We have used a robotic system to perform thoracoscopic surgery in 12 cases: five lobectomies, three tumor enucleations, three excisions and one bulla stitching completed with fibrin glue for spontaneous pneumothorax. The operations were performed using the Intuitive Microsurgical system (Da Vinci System) through three ports and, a fourth space 'service entrance' incision, in the major lung resection. Three procedures begun with the robotic technique were completed by a minimal thoracotomy. No technical operative mishaps were associated with the manoeuvres of robotic arms. In all manoeuvres (up, down, insertion, extraction, etc.), the robotic arms moved appropriately in the favorable operative fields. All patients tolerated the procedure well and the post-operative course was satisfactory, requiring few analgesics. Although further studies on robotically assisted procedures are needed to clarify the clinical feasibility of this procedure, the results in our cases are encouraging. We believe that thoracoscopic procedures using a robotic manipulation system may be technically feasible in selected cases and in the hands of experienced thoracic surgeons.
