Robotic-assisted lobectomy in non-intubated patient for early stage non-small-cell lung cancer treatment

Minimally invasive surgery is the gold standard to perform pulmonary lobectomy for early-stage non-small cell lung cancer. Recently, non-intubated video-assisted thoracoscopic surgery (NI-VATS), based on spontaneous ventilation under sedation and regional anaesthesia, has emerged as less invasive alternative to conventional anaesthesia, reporting several benefits but its application in major pulmonary resection remains controversial. We present the first report of robotic-assisted surgery (RATS) to perform a right lower lobectomy with radical lymph-node dissection in a non-intubated patient presenting a pulmonary adenocarcinoma. In our experience, this approach is feasible, combining the ergonomic and precision advantages of robotic technology with the potential physiological benefits of spontaneous ventilation further reducing the invasiveness of both surgery and anaesthesia This innovative combination may be defined as non-intubated robotic-assisted thoracic surgery: NI-RATS.