The fully equipped Department of Thoracic Surgery is one of the pioneering departments of Metropolitan General. The range of procedures it covers includes both diagnostic and therapeutic interventions of the lungs, mediastinum, chest wall, and esophagus.
Since its establishment, major lung procedures have been performed, including lobectomies and pneumonectomies. Today, the Department of Thoracic Surgery continues to lead with minimally invasive thoracoscopic procedures performed through very small skin incisions using camera guidance.
With this method, diagnostic procedures of the lungs and pleural cavity are performed, as well as major therapeutic interventions such as lung resections, treatment of hyperhidrosis, and management of atrial fibrillation. Thoracoscopic procedures significantly reduce postoperative pain, provide excellent aesthetic results, and minimize postoperative hospitalization time.
Robotic Thoracic Surgery (Da Vinci)
Robotic surgery is a development of tele-surgery and originated from the need of NASA and the military to perform operations remotely when patients’ lives were at risk. Since its introduction approximately 30 years ago, it has evolved rapidly.
Robotic surgery was developed to provide more flexible instruments, greater range of motion, improved ergonomics for the surgical team, three-dimensional and more precise visualization of the surgical field, and to overcome the limitations associated with procedures in small and confined anatomical areas.
Thoracic Conditions Treated with Robotic Surgery
The introduction of robotic surgery in thoracic procedures has significantly improved both the quality of complex surgical interventions and postoperative patient outcomes.
The main conditions treated include:
- Lung cancer: lobectomies, anatomical resections, pneumonectomies, and lymph node dissection
- Resection of mediastinal tumors such as thymomas, teratomas, and neurogenic tumors
- Thymectomy in patients with myasthenia gravis
- Diaphragm plication in cases of paralysis
- Esophagectomy for esophageal cancer
- Removal of esophageal stromal tumors such as leiomyomas and GIST
Advantages
The advantages of robotic thoracic surgery (RATS - Robotic-Assisted Thoracic Surgery) relate both to surgical precision and patient recovery:
- Complex lung procedures can be performed more effectively due to enhanced instrument flexibility, improved visualization, and superior dexterity. Unnecessary trauma to surrounding tissues is minimized, and lymph node dissection is more thorough compared to both thoracoscopic and open approaches.
- It is minimally invasive, as procedures are performed through 3–4 small incisions in the chest wall.
- Postoperative pain is significantly reduced, as instruments do not injure intercostal nerves. Most patients require only oral analgesics the day after surgery.
- Early mobilization of patients reduces postoperative complications, which is particularly important following lung surgery.
- Hospital stay is shorter, as chest drainage is typically required for only 1–2 days.
- Chronic pain is minimal, allowing rapid return to daily activities.
The first thoracic robotic procedures at Metropolitan General were performed in 2021, and the Clinic now offers the full spectrum of thoracic surgical procedures.
How the Da Vinci Robotic System Works
The Da Vinci Robotic System consists of a surgeon console, the InSite® Vision System providing real-time 3D imaging, and a four-arm system (EndoWrist® technology) to which the surgical instruments are attached.
The surgeon sits at the console within the operating room, at a distance from the patient, and controls the robotic arms. The instruments are introduced into the patient’s body through small incisions made by the surgical team.
Using the three-dimensional view provided by the console, the surgeon manipulates robotic arms through specialized controls. Each arm is connected to a surgical instrument, while the central arm carries the camera. Thanks to EndoWrist® technology, the robotic arms offer significantly greater flexibility than the human wrist, with rotation up to 360°.
The Da Vinci system also features a three-dimensional imaging system that magnifies the surgical field up to 15 times, effectively enhancing the capabilities of human vision and enabling the surgeon to perform highly detailed, precise, and stable movements. The surgeon uses both hand controls and foot pedals to control the camera, adjust focus, and position the robotic arms.
The robot does not replace the surgeon; it functions as an assistant under the surgeon’s full control and guidance, without the ability to act independently. It is an advanced and valuable tool that facilitates the surgeon’s work and enables more effective surgical procedures.