Transitioning from VATS to robotic lobectomy

Advances in surgical techniques have heralded significant growth in the application of robotics to thoracic surgery with even more platforms on the horizon. These will introduce an element of competition and further enhance innovation. There are several reported advantages associated with use of the robotic approach to lobectomy including reduced length of stay and peri-operative complications. High initial capital investment, ongoing costs, and length of operative times are common perceived disincentives to adoption of robotic programs and may influence the decision to use these techniques. Once a surgeon has committed to adoption of robotic techniques, they must be aware of the time commitment and investment required for successful transition. The learning curve for an experienced surgeon in transitioning to robotic surgery is estimated at 18–22 cases by most reports although this may vary significantly based upon surgeon background (VATS vs. open approaches) and experience. Surgeons have several options for training in robotic surgery including formal academic fellowships, mini-fellowships, and tailored mentored skills courses. Ultimately, success rests heavily on team training, proper case and patient selection with gradual increase in extent of a single operation performed and operative complexity. This will guide the surgeon through the transition in a safe and efficient manner.