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Zirafa et al. Mini-invasive Surg 2020;4:13 I http://dx.doi.org/10.20517/2574-1225.2019.35 Page 5 of 6

three-year overall survival of 75%, 73%, 44% and 0% for pI, pII, pIII and pIV, respectively. In a multicentric
[17]
study, Cerfolio et al. described five-year stage-specific survival of 83% for stage IA, 77% for stage IB, 68%
for stage IIA, 70% for stage IIB, 62% for stage IIIA (including N2 disease patients) and 31% for stage IIIB, to
confirm the high quality of the surgical robotic resection.

The recent literature and the increasing diffusion of minimally invasive approaches worldwide in thoracic
field are proclaiming robotic surgery as the present as well as the future in the treatment of lung cancer.

Currently, despite the lack of haptic feedback, featuring the current system (DaVinci, Intuitive Surgical,
Sunnyvale, CA), robotic surgery allows proceeding comfortably and safely during the dissection of lymph
nodes. In fact, the scaled motions, the dexterity, the high geometrical precision and the instrument’s
wide range movement support the surgeon during the lymphadenectomy, making it easier to reach all
the hilar and mediastinal stations without difficulties [Figures 1 and 2]. In addition, taking advantage of
the high definition 3D camera with the 10-fold magnified view of surgical field, the surgeon can perform
the dissection of nodes with a greater accuracy, limiting bleeding and other intraoperative complications.
Thanks to the robotic system features, skilled robotic surgeons have also been able to approach clinical N2
NSCLC treated by neoadjuvant therapy, obtaining positive results, despite the challenges represented by the
tissue rearrangement.

CONCLUSION
Given these results, robotic surgery can constitute an ever more valuable instrument for the surgeons, to
offer a radical and safe operation with minimally invasive approach, also in advanced stage NSCLC or in
complex cases.

DECLARATIONS
Acknowledgments
To Teresa Hung Key for her support and the linguistic accuracy checking.

Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Zirafa CC
Performed data acquisition, as well as provided administrative, technical, and material support: Romano G,
Nesti A, Davini F, Melfi F

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Prof. F Melfi is an official proctor for Intuitive Surgical. The other authors have no conflicts of interest to
declare.

Ethical approval and consent to participate
Not applicable.