Advanced Robotic Pulmonary Surgery

A diagnosis involving the lungs can understandably raise questions about surgery, recovery, postoperative discomfort, hospitalization, and the time required to return to normal activities. Advances in minimally invasive thoracic surgery have significantly expanded the options available for treating a wide range of pulmonary conditions.

At the Institute for Thoracic Surgery in Miami, Florida, Mark R. Dylewski, M.D., specializes in advanced minimally invasive and robotic-assisted pulmonary surgery. Using state-of-the-art robotic technology, Dr. Dylewski performs selected lung and thoracic procedures through small incisions, avoiding the large chest incision traditionally associated with open thoracic surgery whenever an appropriate minimally invasive approach can be safely performed.

Precision Through Robotic Technology

Robotic pulmonary surgery combines the principles of minimally invasive surgery with advanced three-dimensional visualization, magnification, and highly articulated surgical instruments. These capabilities provide the surgeon with enhanced visualization and precise instrument control within the chest, facilitating meticulous dissection and reconstruction while minimizing disruption to the chest wall.

For appropriately selected patients, minimally invasive pulmonary surgery may provide meaningful advantages compared with traditional open surgery. These may include smaller incisions, reduced disruption of the chest wall, less postoperative discomfort, earlier mobilization, shorter hospital stays, and a more rapid return to normal daily activities.

Individualized Surgical Approach

Robotic surgery is not appropriate for every patient or every pulmonary condition. The optimal surgical approach depends on multiple factors, including the patient's diagnosis, anatomy, prior treatments or operations, and the complexity of the procedure. Depending on these considerations, surgery may be performed using a robotic, video-assisted thoracoscopic (VATS), or traditional open approach.

At the Institute for Thoracic Surgery, advanced technology is a means to an end—not the objective itself. Our goal is to select the surgical approach that provides each patient with the safest, most precise, and least disruptive treatment appropriate for their individual condition.

Through specialized expertise in minimally invasive thoracic surgery and advanced robotic techniques, our focus remains on achieving excellent surgical outcomes while minimizing the physical impact of surgery whenever safely possible.

Advanced Robotic Pulmonary Surgery

Precision, Visualization and Minimally Invasive Lung Surgery

Robotic pulmonary surgery represents one of the most advanced approaches to minimally invasive thoracic surgery. Instead of performing an operation through a large chest incision and spreading the ribs apart, robotic-assisted surgery allows selected lung procedures to be performed through several small incisions—or, with appropriate procedures, through a single-port approach.

Dr. Mark R. Dylewski performs robotic-assisted thoracic surgery using advanced robotic technology to treat a wide range of pulmonary and thoracic conditions.

During robotic surgery, the surgeon remains completely in control of the operation. The robotic system does not operate independently. Rather, it translates the surgeon's hand movements at a console into precise movements of small, articulated instruments inside the chest.

A high-definition, magnified three-dimensional camera provides an enhanced view of the anatomy. The combination of three-dimensional visualization, instrument articulation, motion scaling, and tremor filtration can provide important technical advantages when operating around delicate structures such as pulmonary arteries, veins, bronchi, lymph nodes, and the mediastinum.

The goal is straightforward: to perform the necessary operation while minimizing unnecessary trauma to the chest.

How Is Robotic Pulmonary Surgery Different From Traditional Open Surgery?

Traditional open lung surgery, known as a thoracotomy, requires a relatively large incision and may require spreading the ribs to gain access to the chest.

Thoracotomy remains an important surgical approach and is sometimes the safest or most appropriate option, particularly for very large tumors, extensive disease, complex reconstruction, or situations in which minimally invasive surgery cannot safely accomplish the operation.

When a minimally invasive approach is appropriate, however, robotic surgery can avoid many of the limitations associated with a large thoracotomy.

Potential advantages include:

• Smaller incisions
• Avoidance of routine rib spreading
• Magnified three-dimensional visualization
• Wristed, articulated instruments
• Motion scaling and tremor filtration
• Precise dissection around critical structures
• Potential for reduced blood loss
• Less disruption of the chest wall
• Potentially less postoperative pain
• Earlier mobilization and recovery in appropriately selected patients

Studies comparing minimally invasive and open lung surgery have generally demonstrated advantages of minimally invasive approaches in areas such as recovery and hospital stay. The exact benefit varies according to the operation, patient's condition, and surgical technique.

Robotic Surgery Compared With Traditional VATS

Video-assisted thoracic surgery (VATS) was a major advancement in thoracic surgery and remains an excellent minimally invasive approach.

Robotic surgery builds upon many of the principles of VATS while introducing additional technological capabilities.

Three-Dimensional Visualization

Traditional VATS typically relies on a camera providing an image on a monitor. Modern robotic systems provide an immersive, magnified three-dimensional view that can enhance depth perception and anatomical visualization.

Wristed Instrumentation

Conventional VATS instruments are relatively rigid and have limited articulation. Robotic instruments are designed with wristed articulation that allows the surgeon to perform complex movements within the chest.

This can be particularly helpful during meticulous dissection around pulmonary vessels, bronchi, lymph nodes, and other structures.

Surgeon-Controlled Precision

The surgeon controls the robotic instruments directly from the console. Robotic systems incorporate motion scaling and tremor filtration, allowing large hand movements to be translated into smaller, controlled instrument movements.

Complex Dissection

The combination of three-dimensional visualization and articulated instruments may provide technical advantages during anatomically demanding procedures.

Importantly, robotic surgery should not be presented as universally superior to VATS. Recent randomized evidence has found broadly comparable perioperative and oncologic outcomes between robotic and VATS lobectomy, while other studies have identified potential differences in blood loss, lymph-node assessment, conversion rates, or hospital stay. The choice of technique should therefore be individualized according to the patient's anatomy, disease, procedure, and surgeon expertise.

The Evolution of Robotic Thoracic Surgery

Robotic technology continues to evolve rapidly. Different robotic platforms offer different capabilities, and the most appropriate system depends on the operation being performed.

da Vinci Xi

The da Vinci Xi is an established multiport robotic platform used extensively for minimally invasive surgery.

For thoracic surgery, the Xi provides high-definition three-dimensional visualization, articulated instruments, motion scaling, tremor filtration, and advanced imaging capabilities such as Firefly fluorescence imaging. Its multiport configuration provides flexibility for complex operations involving different areas of the chest.

The Xi has become an important platform for procedures including anatomic lung resections, mediastinal surgery, thymectomy, and other complex thoracic operations.

da Vinci 5

The da Vinci 5 represents the next generation of multiport robotic technology.

The platform incorporates more than 150 design innovations and substantially increased computing capabilities compared with previous-generation systems. It provides an enhanced three-dimensional visualization system, improved ergonomics, advanced software capabilities, and Force Feedback technology.

Force Feedback

One of the most notable innovations of the da Vinci 5 is Force Feedback.

Force Feedback allows the surgeon to receive information about push and pull forces being exerted at the instrument tip. This provides an additional sensory input beyond visual information.

Preclinical studies have demonstrated that Force Feedback can reduce the amount of force applied to tissue during simulated surgical tasks; however, these findings should not be interpreted as proof that the technology independently improves clinical outcomes for every operation.

The significance of this technology is its potential to give the surgeon another layer of information while performing delicate dissection and reconstruction.

da Vinci SP — Single-Port Robotic Surgery

The da Vinci SP represents another evolution in minimally invasive surgery.

Unlike conventional multiport robotic surgery, the SP system is specifically designed to allow robotic surgery through a single access point for appropriately selected procedures. It incorporates an articulating three-dimensional camera and three wristed instruments that operate through the single port.

Single-port robotic surgery may be particularly useful when the surgical target can be effectively reached through a single access site.

Potential advantages include:

• A single primary access incision
• Reduced number of chest-wall access sites
• Three-dimensional visualization
• Articulating instruments
• Ability to operate in confined anatomical spaces

The SP platform is not appropriate for every lung operation. Patient anatomy, tumor location, disease complexity, and the specific surgical procedure determine whether a single-port approach is appropriate.

The Future of Robotic Surgery: Ottava

The next generation of robotic surgery is continuing to evolve toward greater integration of imaging, digital technology, surgical data, advanced instrumentation, and potentially computer-assisted capabilities.

Ottava, Intuitive's next-generation robotic platform, is part of this ongoing development. It is important, however, to distinguish future technology from currently available clinical platforms. As of 2026, Ottava remains a developmental technology rather than a routinely available clinical surgical system.

The continuing development of platforms such as Ottava illustrates the direction of modern surgery: increasingly sophisticated minimally invasive techniques designed to provide surgeons with greater visualization, control, information, and flexibility.

What Conditions Can Robotic Pulmonary Surgery Treat?

Robotic-assisted pulmonary surgery may be appropriate for a variety of conditions, depending upon the patient's anatomy and the nature and extent of disease.

These may include:

Lung Cancer

Robotic surgery can be used for selected patients requiring:

• Wedge resection
• Segmentectomy
• Lobectomy
• Complex pulmonary resections
• Mediastinal and lymph-node evaluation

For appropriately selected early-stage lung cancer patients, minimally invasive anatomic lung resection can provide an alternative to open surgery.

Pulmonary Nodules

Suspicious or indeterminate lung nodules may require surgical biopsy or removal when imaging, biopsy, or clinical circumstances warrant tissue diagnosis or definitive treatment.

Benign Lung Tumors

Selected benign pulmonary tumors and other nonmalignant lung lesions may be treated using minimally invasive techniques.

Metastatic Disease

Patients with selected metastatic tumors involving the lungs may be candidates for minimally invasive pulmonary resection depending on the number, location, and distribution of lesions and their overall oncologic treatment plan.

Pleural and Other Thoracic Conditions

Robotic technology can also be used for selected procedures involving the pleura, mediastinum, diaphragm, thymus, and other structures within the chest.

Not every patient or disease is appropriate for robotic surgery. A careful evaluation is necessary to determine the safest and most effective approach.

Robotic Surgery and Recovery

One of the principal goals of minimally invasive thoracic surgery is to minimize disruption of the chest wall while accomplishing the same fundamental surgical objective.

Compared with a traditional thoracotomy, appropriately selected patients undergoing minimally invasive surgery may experience:

• Less postoperative discomfort
• Earlier mobilization
• Shorter hospitalization
• Faster return to normal activities
• Smaller surgical scars
• Less disruption of the chest wall

Recovery depends on many factors, including the type and extent of the operation, the patient's age and overall health, pulmonary function, and whether additional treatments such as chemotherapy or radiation are required.

Robotic surgery does not eliminate the risks associated with lung surgery, and patients should understand that conversion to VATS or open surgery may occasionally be necessary when this is determined to be safer during the operation.

Advanced Robotic Surgery Is About More Than the Robot

The robotic platform is a sophisticated surgical instrument—but the technology does not replace surgical judgment or experience.

The most important decision is determining which operation is appropriate for the individual patient and which surgical approach provides the safest and most effective treatment.

For one patient, this may be a multiport robotic procedure using the da Vinci Xi or da Vinci 5. For another, a single-port da Vinci SP approach may be appropriate. Some patients are better served by conventional VATS, while others require an open operation.

The goal is not to perform every operation robotically.

The goal is to provide the right operation, through the least disruptive approach that can safely and completely accomplish the surgical objective.

At the Institute for Thoracic Surgery, advanced robotic technology is incorporated into a comprehensive approach to thoracic disease, combining modern minimally invasive techniques with individualized surgical planning and extensive thoracic surgical expertise.

If you or a loved one has been diagnosed with a lung nodule, lung cancer, or another condition requiring thoracic surgery, a consultation with our seasoned experts can help determine whether robotic pulmonary surgery—or another surgical approach—is appropriate for your individual condition.