Surgery is the treatment of choice in early-stage lung cancer and has traditionally been performed through a large cut on the side of the chest. This results in increased pain and a longer hospital stay for patients.
Robot-assisted thoracic surgery is a minimal-access approach that allows surgeons to perform operations remotely, using robotic arms inserted through several small incisions. With this technology available at Tan Tock Seng Hospital, our patients are able to experience less pain and a shorter hospital stay.
Lung cancer is a leading cause of death from cancer in Singapore. The treatment of lung cancer depends on a number of factors such as the extent of the cancer (stage) and the patient’s overall health. Surgery is one of the treatment options available to patients and traditionally involves the use of a large cut on the side of the chest. This increases postoperative discomfort and patient requires a longer hospital stay to recover from the surgery.
Over the years, Video-Assisted Thoracic Surgery (VATS), a minimalaccess approach that allows surgeons to perform lung cancer surgery through three to four small incisions was introduced. However, VATS demands skills that are very different from the hand motions used in traditional open surgery, and hence requires longer training times to master such procedures. Robot-assisted thoracic surgery is an extension of VATS and this technology is able to replicate the surgeon’s hand movements precisely. Consequently, the training time required to master the movements using the robot is much shorter, resulting in its widespread acceptance in the USA and Europe.
1. Robot-Assisted Wedge Resection
With this procedure, the surgeon removes a small wedge-shaped portion of the lung, which includes the cancer and some healthy tissue surrounding the tumour.
2. Robot-Assisted Sub-Lobar Resection
With this procedure, the surgeon removes a segment of the lobe containing the cancer, with some normal surrounding lung tissue.
3. Robot-Assisted Lobectomy
With this procedure, the surgeon removes the entire lobe containing the cancer, for example, the left upper lobe.
How Does Robotic Surgery Work?
The surgical robot was originally developed by the US military, to allow complex surgery to be performed on a wounded soldier by a surgeon on a console at a hospital, removed from the battlefield. The robot provides enhanced vision and control and is made up of several components, which includes an ergonomically-designed console, four interactive robotic arms and a three-dimensional (3D), highdefinition vision system. The four interactive robot arms are introduced into the patient’s chest using small incisions, while the surgeon sits at the console and uses finger, eye and foot controls to manipulate the arms of the robot.
Robot-Assisted Surgery for Lung Cancer
In robotic lung cancer surgery, surgeons operate through small incisions in the chest to remove the cancer and a certain amount of surrounding healthy tissue from the affected lobe of the lung. The right lung consists of three lobes, while the left lung is made up of two. At Tan Tock Seng Hospital (TTSH), several different types of lung cancer operations are performed, depending on the size and the location of the tumour.
Regardless of the type of procedure performed, surgical removal of the lymph nodes surrounding the lung is also performed using the robot. This allows the surgeon to determine if the cancer has progressed beyond the lungs.
Advantages of Robot-Assisted Lung Cancer Surgery
'Robot' used in thoracic surgery for the treatment of early-stage lung cancer.
Robot-assisted lung cancer surgery is performed through a series of small incisions, which results in faster recovery and significantly less post-operative discomfort and scarring, as compared to traditional open lung cancer surgery that requires a large incision.
Since the introduction of robotic lung cancer surgery at TTSH in 2012, we have seen an improvement in our patients’ post-operative recovery as well as reduced hospital stays (three to four days).
The other advantage of using robotic surgery in lung cancer includes the surgical robot’s high definition, 3D camera, which provides a superior view of the tissues being operated on. The robot is also able to translate the surgeon’s hand, wrist and finger movements into real-time movements of the surgical instruments inside the patient.
This allows for exceptional precision, which is ideal for resecting lung tissues and removing lymph nodes within the chest.
Working as a Team in Robot-Assisted Lung Cancer Surgery
At TTSH, we offer a team-based approach to robot-assisted thoracic surgery. Surgeons are accompanied by a team of trained nurses and supporting healthcare staff to ensure that every patient receives quality and personalised care.
Dr. Dokev Basheer Ahmed Aneez Ahmed
Dr. Aneez Ahmed is the Chief and Senior Consultant of Thoracic Surgery Service in the Department of General Surgery of Tan Tock Seng Hospital, Singapore. He obtained a Level III Certificate Specialist training in Robotic Thoracic Surgery from European Association of Cardiothoracic Surgery (EACTS). He is a board member of the regional ASEAN VATS Study Group and is also a member of the editorial review board of the Singapore Medical Journal (SMJ). He has undergone further training in Germany, Europe and United States in his specialised area of service in laser application in thoracic and robotic surgeries.