A review of managing catastrophes in robotic-assisted thoracic surgery

摘要

Abstract: Lung cancer is the most commonly diagnosed cancer worldwide in 2022, with over 2.5 million new cases, or 1 in 8 of all cancers diagnosed worldwide. Lung cancer is the leading cause of cancer related mortality in the United States, with non-small cell lung cancer (NSCLC) being the most prevalent type. For early-stage NSCLC, lung resection with anatomic lobectomy remains the standard of care. Robot-assisted lobectomy is gaining popularity over video-assisted thoracoscopic surgery (VATS) and open thoracotomy due to improved visualization, ergonomics, and instrumentation. Despite these advancements, intraoperative complications and a steep learning curve present significant barriers to the widespread adoption of robotic techniques. This review addresses the management of catastrophic complications during robot-assisted lobectomy, including tracheobronchial, pulmonary artery, and pulmonary vein injuries. Tracheobronchial injuries, though rare, are life-threatening and require immediate diagnosis and intervention. Pulmonary artery injuries, the most common catastrophic event, demand precise and rapid response strategies. Pulmonary vein injuries, typically managed with pressure and surgical repair, also necessitate prompt action to prevent adverse outcomes. Neoadjuvant immunotherapy has added complexity to lung cancer surgeries with changes in tissue and fibrosis, complicating resections. Despite these challenges, clinical trials like CheckMate-816 and KEYNOTE-671 have shown that combining immunotherapy with traditional treatments can improve survival rates and pathological complete response (pCR) rates. However, there are no clear guidelines on the timing of surgery post-immunotherapy, and the balance between poor wound healing and dense fibrosis is crucial. This paper equips surgeons with an array of tips and techniques to manage catastrophic complications and prevent conversion to thoracotomy. It underscores that seeking assistance and converting to open surgery when necessary is not a failure. The evolving landscape of lung cancer treatment emphasizes the need for ongoing research and adaptation of surgical techniques. Multidisciplinary approaches, incorporating advanced imaging, meticulous surgical planning, and strategic use of both conservative and surgical interventions, are essential for improving patient outcomes in lung cancer surgeries post-immunotherapy.