Italy has been historically among the leading countries for the use of robotic surgery, in particular thoracic surgery, where Italians are among the pioneers in the world, with the first interventions in 2002 in Pisa and Grosseto and in 2006 in Milan. Should we therefore imagine that the future will lead us towards a greater spread of robotic surgery? We talked about it with Dr. Giulia Veronesi, Head of the Robotic Surgery Section of the Thoracic Surgery Unit at Humanitas.

High but sustainable costs from the National Health System

Minimally invasive robotic lung cancer interventions are spreading more and more rapidly. In the United States, the robot is used in 15% of lung resections.

As with all new technologies, costs are still very high, both because the machines are very sophisticated and because there is still a monopoly on the market. However, Humanitas research into the costs of applying these new technologies has shown that robotics is also sustainable with the National Health System.

The advantages of robotic surgery

“Compared to video-therapy, i.e. the minimally invasive manual approach forerunner of robotics, robotics has brought indisputable technical advantages, such as greater ergonomics and precision of movements and the optimization of vision, which is three-dimensional and immersive – said Dr. Veronesi – The benefits for patients are mainly documented compared to traditional open surgery in terms of post-operative course and complications. Compared to this, in fact, the robotic approach allows replication of the same surgical phases but with reduced trauma for patients, thus preserving their quality of life.

“A further mark of the “superiority” of minimally invasive robotics compared to the manual is also – explains Dr. Veronesi – the greater effectiveness in removing mediastinal lymph nodes and to go where manual videothoracoscopy cannot go”.

It allows the indications of minimally invasive surgery to be extended to complex cases such as anatomical segmentectomies indicated for very small tumors or cases of locally advanced tumors after chemotherapy. In this way, more patients can benefit from non-traumatic treatments than in the past. An obstacle to the spread of robotic surgery is the cost of the equipment and instruments used. Fortunately, some companies are entering the market with alternative instruments at more “democratic” costs, with a potential impact on price reductions.

“One objective for the future is to develop and adopt robotic devices at a cost that is accessible to all”, concluded the specialist.

New techniques of imaging for conservative surgery

With the spread of screening programs and increased use of imaging, more and more patients are fortunately presenting with very early pulmonary cancers for which traditional surgery is often an overtreatment and where a conservative treatment called sublobar is appropriate, i.e. with savings in part of the healthy pulmonary lobe.

The robotic camera allows you to use a particular vision with infrared light that, after injection of a dye called indiocyanine green, illuminates parts of the organ to be preserved with respect to the diseased portions. This technique guides the surgeon through the procedure, facilitating easier identification of the intersegmental plane and therefore more targeted surgery.

Artificial intelligence and digital surgery

Currently at the Humanitas Robotic Thoracic Surgery Unit directed by Dr. Veronesi, the robotic approach is used for the surgery of stage I to stage III nonthrocytoma lung cancer, in selected cases of stage IV resectable oligometastatic lung cancer after systemic therapy, for stage I microcytoma, for benign and resectable malignant mediastinal tumors and for the treatment of myasthenia gravis requiring radical thymectomy.

Without a doubt, the robotic system has revolutionized the panorama of surgery. But the paradigm shift will occur with Artificial Intelligence applications to digital surgery. An intelligent computer with surgical experience related to many operations will guide the surgeon during the operation. Essentially, in addition to extending human technical and visual capabilities, it will extend cognitive capabilities.