FlexDex surgical system (FD) represents a 360 articulated device proposed as a needle driver which combines the comfort and ranges of movement of the robotic surgery with the cost effectiveness of normal endoscopic devices. These features highlight how FD is a clear step forward in minimally invasive surgery. As a matter of fact, FD allows surgeons to perform high compelling procedures in a more swift way, increasing the effectiveness and the overall performances and reducing costs, time of anesthesia and related post-operative complications. Accordingly, several studies showed its real usufulness in Urologic, Gynecologic and General Surgery procedures. However, to date studies that evaluated the applicability of FD system in minimally invasive thoracic surgery are not reported. Therefore, the aim of the present study is to test this device on patients who underwent advanced lung surgery through VATS. In order to assess the effectiveness in increasing safety, speed and overall performances, reducing operative time (OT), time of anesthesia (TOA), lenght of stay (LOS) and related post-operative complications will be evaluated. The resulting data will shed light on the applicability of FD system in the field of thoracic surgery and will be useful to set more effective and safer procedures, ensuring better care and management of patients.
The innovativeness of this project mainly relies in the promising usefulness of FD system in the field of thoracic surgery. As a matter of fact, FD system allows a robotic-like articulation, able to perform challenging procedures and reach difficult locations in patients with major airways involvement by lung cancer with minimal invasion such as sleeve lobectomies where an articulated device can reproduce the same movement of the classic open technique, increasing precision and overall results when suturing airways. Indeed, this represents one of the several limitations when performing minimally invasive surgery on airways because of the dramatic difficulties in finding the right angle to put stiches and obtaining a proper anastomosis with the standard needle holder. In these cases the FD system, thanks to its intuitive control by the surgeon, leads to a safer and more effective performance. Of note, studies that assessed the potentiality and benefits of FD system in thoracic surgeries are not reported, which raises the need of testing this system, evaluating the applicability, the ergonomics and the related clinical outcome for thoracic surgeries purposes. I FD system has been evaluated in other fields of surgery, revealing its benefits and usefulness in the performance and safe acceleration of surgical procedures (Criss et al., 2017; Khan et al., 2019). Moreover, FD system proved to be extremely cost-effective with respect to robotic surgery, for which indeed specific infrastructures are required. Therefore the positive outcomes of the application of FD system in thoracic surgery will ensure the optimization of procedures in a cost-effective manner, leading to better care and management of patients thanks to a fast recovery, reduced post-operative pain and decrease of hospitalization when compared to the open procedures.