Emerging Technologies in Thoracic Surgery.

The evolution of our practice as thoracic surgeons continues to lean toward more minimally invasive and endoscopic procedures. During the last decade, we have witnessed a transition from video-assisted thoracic surgical approaches to a robotic platform. This has been the source of much of the discussion at our specialty meetings and congresses. This revolution into robotic surgery has forced many surgeons to adopt an entirely new way of operating. Although sometimes difficult, transition to this platform has allowed more patients access to minimally invasive procedures to treat some of the most common diseases we see, namely lung cancer.1Perwaiz M.K. Interventional pulmonologist and thoracic surgeon: a difficult but necessary relationship.J Bronchology Interv Pulmonol. 2017; 24: e1Crossref Scopus (0) Google Scholar,2Chen-Yoshikawa T.F. Fukui T. Nakamura S. et al.J Med Sci. 2020; 82: 161-174Google Scholar This introduction of the robotic platform has been led by surgeons, and the training in these techniques has been disseminated by surgeons to surgeons. The decades in front of us will see the evolution of many more minimally invasive types of treatments, namely endoluminal therapies. The development of these technologies represents a unique dilemma for thoracic surgeons in that many of these new technologies are developed in other specialties, such as gastroenterology or interventional pulmonology. It makes sense, of course, that as medicine and surgery evolve, the types of treatment we provide will only get more minimally invasive, and this requires the willingness and ability to collaborate with specialists who are not technically trained as surgeons but rather as advanced proceduralists. For this reason, a significant portion of this issue is focused on topics that we currently collaborated in with our pulmonary and gastrointestinal colleagues. As we all have observed, there is a growing number of thoracic surgery programs that are evolving into thoracic procedural service lines in which interventional pulmonologists and thoracic surgeons are housed in the same division or department. I have observed this directly, and I believe this type of noncompetitive collegial environment is the way of the future and will allow for more rapid and unbiased development of minimally invasive technology to treat our patients. These multidisciplinary efforts will also allow thoracic surgeons to be trained in all areas of minimally invasive pulmonary therapeutics in the future. This paradigm may also influence our interactions with our gastroenterology colleagues. The remainder of this issue focuses on theoretical advances that we may witness, including lung transplantation using xenografts, intraoperative molecular imaging of tumors, and the potential use of three-dimensional printing in our specialty that may or may not become part of our clinical practice. To provide a review of some of the latest advances in thoracic surgery, experts from multiple disciplines and geographic areas were invited to contribute their knowledge of specific areas of the latest developments in thoracic surgery as well as potential technology of the future. Although there is not a specific clinical theme for this issue, the topics represented touch on many areas that are currently at the forefront of clinical practice and research in thoracic surgery. It has been a privilege to serve as an editor for this issue of Thoracic Surgery Clinics and to highlight some of the work being done by our colleagues.