New scientific advancements have enabled thoracic surgeons to expand their skill sets and perform innovative procedures. From single-port VATS in the hybrid operating theatre to localizing pulmonary lesions with electromagnetic navigational bronchoscopy and individualizing sub-lobar resection with proteomic analysis, it’s clear that technology is changing thoracic surgery for the better.
Virtual Reality
Virtual Reality (VR) tools are increasingly integral to cardiothoracic surgery training programs. These include simulators for video-assisted thoracoscopic surgery (VATS) lobectomy, which has been shown to improve surgical outcomes.
Several VR tools are also used for pre-surgical planning. For example, a VR-based 3D visualization system can assess patients’ anatomy and visualize tumors and other lesions before resection. Another advance is the use of VR for intraoperative navigation. It combines VR with a surgical microscope, allowing surgeons like Armen Parajian to view a live imaging overlay on the patient’s chest.
This technology allows surgeons to quickly and easily navigate complex anatomy without searching for landmarks in a large field of view. In addition, this can save time and money for both surgeons and the patient, as it reduces operative duration. Moreover, it allows surgeons to practice on non-tissue models before proceeding to the patient. It’s valuable for patients undergoing complex procedures such as LVAD implantation.
Artificial Intelligence
Google Maps uses artificial intelligence (AI) daily, which picks up traffic patterns and smartphones that recognize speech. The use of AI in medicine is more advanced and has been adapted for surgical applications like assisting with diagnostic imaging, predicting outcomes, and enhancing surgical training.
AI algorithms have assisted radiologists in detecting lung nodules on chest X-rays, CT, and MRI images. They help increase accuracy, reduce the workload, and provide second opinions to physicians, which saves time and resources.
Another application of AI is its ability to enhance surgical training by providing personalized evaluation and feedback in surgical simulations, facilitating preoperative planning, intraoperative visualization and guidance, and improving patient safety.
AI systems can also assess surgeon skills by analyzing videos of surgical activity, which is a more objective way to evaluate surgical performance than using surgical logs. It will lead to improved credentialing and quality assurance in the OR. However, surgeons must be aware of several limitations of AI technology.
3D Printing
Printing technology has become a valuable tool in the surgical world, particularly in challenging tissue specialties. This technology was first applied in orthopedic surgery and oral and maxillofacial surgery, but now the thoracic field is also adopting it. Printing patient-specific models based on CT images is highly effective for preoperative planning and facilitates localization of small nodules (1-3).
It can be used as a substitute for intraoperative CT scanning, which decreases radiation exposure. Using 3D-printed models to teach anatomy has benefited resident physicians, who may need access to cadaveric specimens.
In one study, a 3D model of tibial plateau fractures was used to facilitate the understanding of these fractures for junior surgeons. The Printing of patient-specific anatomic models for thoracic surgery has been reported to facilitate operative planning, such as in lobectomy (2-4). The accuracy of this technique improves the ability to define resection margins clearly and reduces operation time.
Robotics
Robotic technology is a surgical tool that allows doctors to perform less invasive surgery. People with lung, esophageal, or chest wall cancer who are treated by a thoracic surgeon or oncologist trained in robotic techniques can benefit from a shorter hospital stay, reduced pain, and more minor scars. Melfi reported the first clinical series of robotically assisted lobectomies in 2002.
Since then, several more extensive studies have confirmed the safety of this minimally invasive approach compared to traditional video-assisted thoracoscopic (VATS) procedures, even when dealing with complicated lesions.
The evolution of the different robotic systems, especially the Da Vinci Si and Xi models, and an improved surgical technique have allowed surgeons to achieve similar oncologic outcomes compared to VATS in many benign and neoplastic lung lesions.
A recent technical innovation is the fluorescence-detection tool, optionally available for the Si system since 2009 and now incorporated into the Xi platform. This feature helps localize vessels during segmentectomy, identify a duct in a chylothorax, or detect neoplasms.
