**Author details**

universal and there were lower incidences of pneumonia and atrial fibrillation, improved shoulder range of motion and pulmonary function, less hospital stay and need for nursing

**Figure 2.** Video assisted thracoscopic surgical (VATS) approach for lung resection. The anterior utility incision provides access to majority of the dissection. Endoscopic stapling device make this surgical approach for lung resection safe

The late 1990's saw the development of robotic surgical systems with Intuitive's da Vinci system. The technique utilizes instruments that hinge on a chest wall fulcrum and operate within a cone. The da Vinci system uses multiarticulated instruments that provide seven degrees of rotational freedom, akin to a surgeon's wrist and can be placed exactly where dissection is needed with three-dimensional optics. The skin incisions and trocars are not appreciably different from VATS but the mobility at the end of the instrument is. Da Vinci can be used to retract, grasp, cut, ligate and suture. There is however absence of haptic feedback

**Figure 3.** Robotic approach to lung resection is the latest evolution in lung resection. The surgeon operates from a remote location using the console to control the robot that is 'docked' to the patient. The instrument articulations are such, it is more versatile than the human hand, allowing detail dissection in small spaces, however lacks the tactile

and therefore tension of tissues is determined solely from visual input (Figure 3).

home transfers.[22]

52 Principles and Practice of Cardiothoracic Surgery

and feasible.

sensation.

Trevor Williams and Wickii T. Vigneswaran\*

\*Address all correspondence to: wvignesw@surgery.bsd.uchicago.edu

Department of Surgery, University Of Chicago Medicine, Chicago, IL, USA
