Prolonged air leak after robotic lung resection: a narrative review

Area of Science:

• Thoracic Surgery
• Surgical Technology
• Pulmonary Medicine

Background:

• Prolonged air leak (PAL) increases morbidity and costs after lung resection.
• Robotic-assisted thoracic surgery (RATS) shows comparable outcomes to VATS with potential sublobar resection benefits.
• Focus on PAL incidence, clinical impact, and treatment in robotic surgery.

Purpose of the Study:

• To investigate the incidence and clinical impact of prolonged air leak (PAL) in robotic-assisted thoracic surgery (RATS).
• To discuss current therapeutic strategies for managing PAL in the context of robotic lung resections.
• To evaluate RATS as an alternative to VATS and open thoracotomy for reducing PAL.

Main Methods:

• Literature search on PubMed/MEDLINE and Scopus databases.
• Inclusion of English-language studies published up to May 27, 2022.
• Focus on studies reporting PAL occurrence following RATS.

Main Results:

• Robotic surgery significantly reduces PAL compared to open thoracotomy.
• No clear advantage of RATS over VATS in PAL occurrence was identified.
• Enhanced robotic visualization and dexterity are beneficial for complex sublobar resections.
• Patient selection and intraoperative measures can minimize PAL risk.

Conclusions:

• Robotic lung resection is a safe alternative to open thoracotomy, reducing PAL.
• RATS is a viable alternative to manual VATS.
• RATS is increasingly the preferred technique for sublobar resections in early-stage lung cancer.