Is there a time when the robotic thoracic surgeon should limit or stop video assisted thoracoscopic surgery?

Abstract

Robotic thoracic surgery continues to progress rapidly with the volume of operations undertaken robotically continuing to increase and the range and complexity of surgery also increasing. There is a growing body of literature related to the good clinical outcomes that can be achieved by robotic assisted thoracic surgery (RATS).  Alongside RATS as a minimally invasive surgical approach, avoiding rib spreading and utilising smaller incisions, is video assisted thoracoscopic surgery (VATs).  VATS has been firmly established with RCT evidence of benefits in areas such as surgery for early stage lung cancer when compared to open surgery but where VATS continues to be undertaken, there is a progressive increase in surgery being done robotically.  Following on from the robotic program being established in our unit in 2019, we have undertaken hundreds of robotic thoracic cases with excellent clinical outcomes and having also recently undertaken emergency robotic thoracic surgery with both a good surgical experience and most importantly a good clinical outcome for our patient. It is from this perspective that we ask if there is a time when the robotic surgeon should limit or potentially even stop their VATS practice?