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What is thoracic robotic surgery?

Thoracic robotic surgery is a minimally invasive procedure in which the surgeon makes several tiny incisions between the ribs, then inserts small robotic arms and a camera through the incisions. Special tools attached to the robotic arms allow the surgeon to cut, grasp and stitch.

During the procedure, the surgeon sits at a computer console while the camera provides a 3D view of the lungs or chest area magnified 10 times greater than a person's normal vision. The surgeon's hands control the robotic arms from the console, giving him or her greater range of motion than human hands. The robotic arms also translate the surgeon's larger hand movements into smaller, more precise movements.

Our approach

Northwell Health has a rich history in thoracic surgery. Our surgeons have been on the forefront of leading-edge technology by pioneering new procedures to bring you the most advanced treatments available. We’re one of only a few health systems and hospitals that offer robotic thoracic procedures.

Types of thoracic robotic surgery

There are several kinds of thoracic robotic surgery:

  • Esophagectomy—This is surgery to remove part or all of the esophagus, the tube that carries food from the throat to the stomach. The esophagus is then rebuilt from part of the stomach or large intestine. The procedure is done mainly to treat esophageal cancer. If the removal is partial, the remaining ends of the esophagus are joined. If the esophagus is removed, the surgeon reshapes your stomach into a tube to create a new esophagus. Surgery to remove the lower esophagus also may be done to treat:
  • Laparoscopic Heller myotomy—This procedure is done to correct achalasia, a disorder of the esophagus that gradually prevents a person from swallowing foods and liquids. As the muscles of the upper esophagus weaken, they become unable to move food from the esophagus down to the stomach, and at the same time, the lower esophageal muscle doesn’t totally relax, making it difficult for food to get into the stomach. 

    A Heller myotomy weakens the muscles between the esophagus and the stomach, which helps the valve between them stay open. It is performed through a small incision above the navel. A hollow tube (trocar) is inserted to fill the abdomen with carbon dioxide, making the organs more visible for the scope’s camera. Film images from the camera are shown on monitors. The surgeon then makes four more small incisions and inserts trocars for placing the instruments used in the procedure.

    The surgeon separates the esophagus and stomach from the tissue around them and divides their muscles without cutting the inner lining. The tip of the stomach is tucked behind the esophagus (fundoplication) and sewn to the edges of the myotomy to keep it open and to prevent gastroesophageal reflux.
  • Lobectomy—A lobectomy, removal of a large piece of lung, is the most common treatment for lung cancer. For early-stage lung cancer, video-assisted thoracoscopic surgery (VATS) is a less invasive option than traditional thoracotomy. In the VATS procedure, four small incisions are made in the chest, rather than opening up the ribs. A thorascope (small video camera) and surgical tools are inserted into the incisions. Using the images relayed by the camera to a computer monitor, the thoracic surgeon removes the tumor and any affected tissue through the incisions. 

    In the case of early-stage cancer, the surgeon also may remove lymph nodes in the mid-chest area to make sure the cancer has not metastasized. After rinsing out the chest cavity and closing the incisions, the surgeon will place one or two drains to remove excess fluid and air from around the lung; they are removed during the patient’s recovery.
     
  • Thymectomy—Surgical treatment of myasthenia gravis (MG), a neuromuscular disease, is called thymectomy. In MG, the immune system attacks the connections between muscles and nerves, which keeps muscles from receiving nerve signals that tell them when to relax or contract. Muscles become weak, resulting in symptoms that include double vision or blurred vision (weak eye muscles), drooping eyelids (eyelid weakness), difficulty with speaking and swallowing (throat muscle weakness) and weakness of the limbs. The thymus gland plays a role in MG. When tumors of the thymus gland (thymomas) or the gland itself are removed, the MG improves.

    VATS thymectomy surgery is performed through small incisions on the right or left side of the chest, into which narrow tubes with a light and camera at the end are inserted. Surgical instruments are passed through the tubes and the surgeon performs the procedure while viewing the thymus on a monitor. In video-assisted thoracoscopic extended thymectomy (VATET), incisions are made on both sides of the chest and in the neck for a more complete removal of the thymus.
     
  • Repair of hiatal hernia—When the opening (hiatus) in the muscle between the abdomen and diaphragm is too large, some of the stomach can bulge up into the chest. Gastric acid from the stomach can then flow back into the esophagus, causing heartburn (gastro-esophageal reflux disease, or GERD). Hiatal hernia surgery repairs the bulging of the stomach through the muscle. The procedure usually can be done laparoscopically, using very small incisions. (A laparoscopic surgery to treat a hiatal hernia is still major surgery, however.) Small incisions are made in the upper abdomen, and the surgeon moves the stomach and lower esophagus back into the abdominal cavity. To prevent reflux, the opening in the diaphragm is tightened and the stomach stitched in position. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication).
     
  • Sympathectomy—Endoscopic thoracic sympathectomy (ETS) is surgery to treat hyperhidrosis, or excessive sweating (usually of the palms or face) if no other treatment has worked. Since the sympathetic nerves control sweating, in this procedure the surgeon cuts the nerves to the area of uncontrolled sweating. The surgery is done through tiny incisions under one arm. During surgery, the lung on the side of the incisions is deflated to prevent air from moving in and out of it, giving the surgeon more room to work. 

    A tiny camera on an endoscope (long, thin flexible tube) is inserted through one of the incisions and into your chest, and other surgical tools are inserted through the other incisions. The surgeon locates the problem nerves to cut or destroy them, after which the lung is inflated and the incisions are sutured. The surgeon then performs the same procedure on the other side of your body.  A small drainage tube may be left in your chest for a short while.
     
  • Pneumonectomy (removal of a lung)
     
  • Laparoscopic repair of paraesophageal hernia
     
  • Other lesser procedures, such as intra-thoracic biopsies and pleural (space between the lung and chest wall) surgery

Recovery

Benefits to a robotic procedure include:

  • Shorter hospital stay
  • Quicker recovery time
  • Less scarring and smaller incisions
  • Less blood loss
  • Decreased pain
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