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What is robotic-assisted thoracic surgery (RATS)?

Robotic-assisted thoracic surgery is a minimally invasive procedure, which is performed through tiny incisions (ports). The Da Vinci Xi Robotic Surgical System, or the robot, is always under the control of the thoracic surgeon during your procedure. Very small instruments will be inserted through the surgical ports, either on the left or the right side of your chest, for the surgeon to use to perform the actual surgery.

Depending on your individual circumstances, other thoracic surgical approaches such as thoracotomy or video-assisted thoracoscopic surgery (VATS) rather than robotic surgery may be the appropriate choice for you. Our thoracic surgeons have extensive experience with each approach and will discuss with you which will be the right procedure for you.

What conditions can be treated by RATS?

At UCLH Westmoreland Street we have a dedicated team of thoracic surgeons that are trained to use the Da Vinci Xi Robotic Surgical System to treat thoracic diseases and disorders such as:

  • Thymoma and thymic carcinoma - a cancer associated with autoimmune disorders. Robotic surgery can be used to remove the thymic tumour.
  • Myasthenia Gravis – a neuromuscular disorder involving the thymus gland. Your surgeon can use the robot to remove the entire thymus gland.
  • Lung cancer – your surgeon can utilise the robot to remove the part of your lung affected by cancer, including the associated lymph nodes.
  • Resection of metastases – the robot can be used to remove cancer lesions in the chest from other primary tumours of the body.
  • Surgery to treat hyperhidrosis (excessive sweating) - your surgeon may recommend a sympathectomy via RATS, which is a transection of the sympathetic chain.

What are the benefits of the robotic- assisted thoracic surgery?

Robotic Surgery (RATS) has key advantages over traditional open and video-assisted thoracoscopic surgery (VATS). Compared to traditional surgery, benefits of robotic thoracic surgery are numerous and include:

  • Less postoperative pain at the incision sites
  • Shorter hospital stay, faster recovery and earlier return to normal activity
  • Fewer possible complications
  • Reduced risk of infection
  • Smaller incision scars
  • More precise assessment of lymph node involvement. The robot provides the surgical team with far greater magnification of the surgical field and allows more precise movements of the surgical instruments

What are the disadvantages of RATS?

  • Cost of treatment
  • Number of small incisions required
  • Longer theatre time

What can I expect during my robotic surgical procedure?

This procedure is performed under general anaesthesia, and in most cases, you will have an opportunity to meet your anaesthetist on the morning of your surgery. Your surgeon will be situated behind a control console in the theatre, and he will be in control of all movements of the robot.

Once you are asleep, the thoracic surgeon will make three to four small (8mm to 12 mm) incisions to allow the robot to access your chest cavity. Through these small incisions a surgical assistant will place the miniaturised instruments of the robot into your thoracic cavity. Your surgeon will then use a variety of different surgical instruments, including a high-definition 3D camera, to carry out the planned procedure.

Will I have drains after the surgery?

After your RATS you will likely have one or two chest drain(s) inserted on the same side as your surgical incisions. Their aim is to remove any extra air, fluid or blood that might collect in the chest. The drain(s) will normally remain in place for 24-48 hours after your procedure, or occasionally longer, depending on the amount of drainage of blood, fluid or air present. The nurses and doctors will frequently monitor your drains and inform you of the plan regarding their removal.

What happens after surgery?

The length of your hospital stay after RATS is usually 2-3 days or longer if there are any delays in your post-operative recovery. Some of the main complications that may occur post RATS include:

  • air leak from the reinflated lung
  • persistent drainage of fluid
  • bleeding
  • chest infection
  • wound infection

What are the risks?

When you are signing your consent form, the surgeon will discuss with you the risks and benefits of the surgery, and you will have the opportunity to ask questions. Any risks associated with general anaesthesia will be explained to you by the anaesthetist on the morning of your procedure.

For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please see our Thoracic Surgery Patient Booklet and Patient Diary. You can get in touch by calling us on 0203 456 6047 or by emailing us at