Seoul National University Bundang Hospital (SNUBH) said a three-year study of 102 patients has shown that a robotic lung cancer surgery approach developed by its thoracic surgery team can reduce the risk of nerve injury while maintaining the safety and effectiveness of conventional surgery.
The hospital said Professor Jung Woo-hyun of its department of cardiovascular and thoracic surgery first performed the technique in 2022.
Professor Jung Woo-hyun (Courtesy of SNUBH)
The procedure, described as an intercostal nerve-sparing robotic lung cancer surgery, inserts the surgical robot below the rib cage rather than through the spaces between the ribs.
Conventional lung cancer surgery typically uses small incisions between the ribs to insert thoracoscopic instruments for lung resection. But thick intercostal nerves run through those spaces, making nerve injury difficult to avoid during surgery.
That can lead to intercostal neuralgia, pain with breathing after surgery, and reduced respiratory function, all of which can weigh on patients’ quality of life.
To address that problem, Jung’s team adopted a subcostal approach, creating an opening below the lowest rib and using a surgical robot instead of standard thoracoscopic instruments.
Because the approach avoids the area where the intercostal nerves are located, the hospital said, it can fundamentally reduce nerve damage.
The robotic system’s long, articulated instruments also allow precise surgery despite the greater distance to the lungs. The hospital said the technique is now also being used in countries including the United States and Canada.
The findings, published in the Journal of Robotic Surgery, were based on a prospective study conducted from June 2022 to June 2025 involving 102 patients with non-small cell lung cancer (NSCLC).
Among the 102 patients, major complications requiring additional surgery or intensive care occurred in two cases, or 1.9 percent, according to the hospital.
Although there had been concerns that approaching from below the rib cage could damage the diaphragm, no cases of diaphragmatic injury were reported.
The hospital also said no cases of pseudohernia, a bulging of the abdomen caused by paralysis of the abdominal wall muscles, were seen in the study group. The team also evaluated whether the subcostal robotic approach could achieve lymph node dissection comparable to existing lung cancer surgery.
Because lung cancer can spread through lymph nodes, surgeons routinely remove lymph nodes around the lungs and in the mediastinum to check for metastasis.
In 47 patients with more advanced disease or a higher risk of metastasis, the team performed extensive dissection of lymph nodes around the lungs and in the mediastinum. The hospital said the procedure removed an average of 20.4 lymph nodes per patient, a level comparable to conventional surgery.
In that group, 11 of the 47 patients, or 23.4 percent, were found after surgery to have lymph node metastases that had not been detected on preoperative CT or PET-CT scans. Eight of those patients were upstaged to N2 disease, according to the paper.
The study also assessed reproducibility using cumulative sum analysis in a subgroup of patients who underwent lobectomy with mediastinal lymph node dissection. The analysis identified the 31st case as the turning point in the learning curve, after which operative time, blood loss and hospital stay declined.
Jung said the significance of the study was that it showed the intercostal nerve-sparing robotic approach could reduce postoperative pain while allowing lung resection and lymph node dissection at a level comparable to existing techniques.
Source: https://www.koreabiomed.com/news/articleView.html?idxno=31277
