Robotic thoracic surgery in inflammatory and infective diseases.

Tuberculosis and inflammatory conditions are endemic in India and South-East Asia. They cause intense inflammatory reactions and adhesions, thus making surgical resection difficult. In 2009, we installed an intuitive da Vinci HDSi robot to perform our surgery as a part of a robotic thoracic surgery unit. We reviewed our practice to report the trials and tribulations of starting a robotic thoracic surgery program in an inflammatory and infective disease endemic third-world country. With the success of the multispecialty robotic surgery program, we were able to purchase a second robot with an operating console and a training console. The robot is an additional tool in the armamentarium of the thoracic surgeon. It provides good vision in inflammatory conditions, facilitates dissection of dense adhesions with minimal blood loss, and the ability of the robotic endowrist allows maximum and safe manipulation at the thoracic outlet. Sleeve resection and sleeve lobectomy are technically possible, due to ease of suturing with the robotic platform. Complex resections for tuberculosis, aspergilloma, inflammatory tumours and post-infective bronchiectasis are safer using the robotic thoracic platform. This is our operation of choice in complex thoracic surgery cases.