Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.
With the integration of 5G communication technology and robotic surgical systems, remote robot-assisted thoracic surgery is overcoming geographical barriers, offering an innovative approach to addressing the uneven distribution of medical resources. This study conducted a systematic literature review—using databases such as PubMed and CNKI, with the search period extending up to 2025—incorporating clinical studies, case reports, and review articles to comprehensively evaluate the clinical efficacy and safety of 5G-enabled remote robot-assisted thoracic surgery (5G-RRATS). The analysis also examined current technological limitations and potential future development trajectories. Existing evidence indicates that, given adequate technical support, 5G-RRATS can achieve perioperative outcomes comparable to those of conventional local robotic surgeries across procedures including pulmonary wedge resection, lobectomy, and esophagectomy. Furthermore, it demonstrates potential advantages in minimizing surgical incisions and reducing intraoperative blood loss. Nevertheless, challenges related to network stability, latency control, interdisciplinary collaboration between medical and engineering teams, and legal, regulatory, and ethical considerations continue to hinder widespread clinical adoption. Looking ahead, the emergence of a "one-to-many" remote surgical model, combined with the integration of artificial intelligence and augmented reality technologies, as well as advancements in low-orbit satellite communications, may enable 5G-RRATS to further advance precision and efficiency in thoracic surgery, thereby facilitating equitable access to high-quality care for a broader patient population.
Lung cancer is the malignant tumor with the highest incidence and mortality in China and even worldwide. Non-small cell lung cancer (NSCLC) constitutes the vast majority of cases. The current innovation in lung cancer diagnosis and treatment systems is progressively transitioning from traditional pathological classification to molecular characteristic-guided precision medicine. However, the conventional gold standard for molecular detection, tissue biopsy, faces limitations including invasive procedures and non-repeatable sample acquisition. The breakthrough in liquid biopsy technology has provided new clinical pathways, particularly through circulating tumor DNA (ctDNA) detection for molecular residual disease (MRD) monitoring, which has emerged as a research hotspot in the liquid biopsy field. Through continuous optimization, this approach has achieved breakthroughs in high sensitivity and specificity. Its non-invasive nature eliminates the risks associated with tissue puncture, demonstrating significant potential in various clinical applications including early and advanced NSCLC diagnosis, treatment response monitoring, drug resistance evaluation, and prognosis prediction.
ObjectiveTo investigate the clinical efficacy of a posterior approach for robot-assisted thoracoscopic anatomical right upper lobectomy. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent da Vinci robot-assisted thoracoscopic anatomical right upper lobectomy at the Department of Thoracic Surgery, Gansu Provincial People's Hospital, from October 2023 to October 2025. Patients were divided into an anterior approach group and a posterior approach group based on the surgical approach. Perioperative outcomes, pain indicators, postoperative complications, inflammatory markers, protein metabolism indicators, and pulmonary function parameters were compared between the two groups. ResultsA total of 80 patients were included. There were 40 patients in the anterior approach group, including 23 males and 17 females with a median age of 64 (60, 65) years; 40 in the posterior approach group, including 22 males and 18 females with a median age of 63 (60, 65) years. The posterior approach group demonstrated significantly shorter operative time, less intraoperative blood loss, lower chest tube drainage volume, and a shorter length of hospital stay compared to the anterior approach group (P＜0.05). Regarding inflammatory indicators, preoperative levels of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) were comparable between the groups. Postoperatively, they exhibited a trend of an initial increase followed by a decrease, and the magnitude of this postoperative increase was significantly lower in the posterior approach group (P＜0.05). For protein metabolism indicators, preoperative levels of prealbumin, albumin, and transferrin were similar. Postoperatively, they showed a trend of an initial decrease followed by a recovery, with a significantly smaller decrease observed in the posterior approach group (P＜0.05). There were no significant differences in preoperative pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and diffusing capacity for carbon monoxide (DLCO), but the postoperative decline in these parameters was less pronounced in the posterior approach group (P＜0.05). Furthermore, there were no statistically significant differences between the two groups in the total number of dissected lymph nodes, postoperative visual analogue scale (VAS) pain scores, or the incidence of complications (P＞0.05). ConclusionThe posterior approach for robot-assisted thoracoscopic anatomical right upper lobectomy is safe and feasible. Its perioperative outcomes are comparable to the traditional anterior approach. This approach may reduce surgical difficulty while lessening the impairment of pulmonary function and maintaining the stability of the patient's internal physiological environment.
ObjectiveTo evaluate the efficacy, safety, and long-term recurrence rate of thoracoscopic bullae resection combined with parietal pleurectomy or pleural abrasion for the treatment of spontaneous pneumothorax. MethodsRelevant literatures were searched in PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, Wanfang and VIP databases from the establishment of each database to February 1, 2025. According to the inclusion and exclusion criteria, the literatures were screened. Meta-analysis was conducted using Review Manager 5.3 software, and the quality of the literatures was evaluated using the Cochrane Bias Risk Assessment Tool and the NOS scale. ResultsA total of 23 articles were included, including 6 randomized controlled studies and 17 retrospective cohort studies, with NOS scores≥7. A total of 3 296 patients were enrolled, including 1 245 in the parietal pleurectomy group and 2 051 in the pleural abrasion group. The meta-analysis results showed that the pleural abrasion group had shorter operation time [MD=19.68, 95%CI (14.12-25.25)], less intraoperative blood loss [MD=11.31, 95%CI (4.20-18.41)], lower postoperative pain score [MD=0.48, 95%CI (0.04-0.91)], lower total postoperative drainage volume [MD=44.31, 95%CI (11.92-76.71)], shorter postoperative drainage time [MD=0.32, 95%CI (0.03-0.60)], and shorter hospital stay [MD=0.40, 95%CI (0.23-0.57)] compared with the parietal pleurectomy group, and the differences were statistically significant (P<0.05). In terms of safety, the parietal pleurectomy group increased the incidence of postoperative pulmonary hemorrhage [OR=3.99, 95%CI (1.49-10.65), P<0.05], but there were no statistically significant differences in the incidence of postoperative atelectasis, pneumothorax leakage and pulmonary infection (P>0.05). In addition, the parietal pleurectomy group could effectively reduce the long-term recurrence rate of patients [OR=0.48, 95%CI (0.36-0.64)], and the difference was statistically significant (P<0.05). ConclusionDecortication inevitably imposes a greater perioperative burden on patients with spontaneous pneumothorax and pulmonary bullae, yet it effectively reduces the risk of postoperative recurrence. While both surgical approaches exhibit similar safety profiles, parietal pleurectomy may elevate the risk of postoperative pulmonary hemorrhage. Therefore, the optimal treatment strategy should be determined based on individual patient characteristics.