Robotics in thoracic surgery

Die Akzeptanz und auch die Verbreitung der robotisch assistierten Thoraxchirurgie (RATS) in Deutschland ist in den vergangenen Jahren eindeutig zunehmend und wird voraussichtlich in den nachsten Jahren weiter deutlich ansteigen. RATS-Techniken sind insbesondere fur anatomische Lungenresektionen, also Segmentektomien und Lobektomien, sowie auch fur die Resektion von Mediastinaltumoren, Zwerchfellrekonstruktionen und Thymektomien pradestiniert. Abstract The increasing diffusion of the robotic-assisted technique in thoracic surgery (RATS) in Germany was initially delayed in comparison with other countries. Therefore, there is a large potential to implement the volume of the surgical procedures performed by RATS. The RATS-technique has many positive aspects. For example, the angulated instruments allow a full wristed dexterity like the human hand, but with a greater range of motion. The surgical Robot has a tremor filter and replicates perfectly the surgeon's movements. Furthermore, the 3D-scope enables an image magnification up to 10 times compared to the normal thoracoscopes. The RATS has also some disadvantages. For example, the operating surgeon sits far away from the patient and is not sterile while performing surgery. This is an important factor in in case of emergency situations, like major bleeding, which often require a conversion to thoracotomy. All robotic systems are built after the same master-slave technology, that allows the operating surgeon to have full control of the master system. The slave system consists of mechanical actuators that respond to the master system's inputs, so the surgical robot will translate every single movement of the surgeon at the console. The main surgical indications for RATS are: mediastinal tumors, diaphragm plication and anatomical lung resection like segment resections, lobectomies or sleeve resections. In the future, the implementation of virtual and augmented reality is expected in the training but also in the planning of RATS-operations.