South Korean researchers have demonstrated the safety and effectiveness of a pioneering robotic surgical technique that removes lung cancer without disturbing the sensitive nerves located between the ribs. The study confirms that "intercostal-sparing robotic lung cancer surgery" can significantly reduce intercostal neuralgia—a chronic post-operative side effect that often severely diminishes a patient’s quality of life.
Professor Jung Woohyun and his team in the Department of Cardiovascular and Thoracic Surgery at Seoul National University Bundang Hospital (SNUBH) reported these findings after analyzing the outcomes of 102 patients with non-small cell lung cancer (NSCLC) over a three-year period. The study was published in the latest issue of the Journal of Robotic Surgery, a leading international publication in the field.
Overcoming the Limitations of Conventional Surgery
Conventional lung cancer surgery typically involves making an incision in the intercostal space—the area between the ribs—to insert thoracoscopic instruments. Because thick intercostal nerves run along these paths, nerve injury is often unavoidable. This frequently results in intercostal neuralgia, causing patients to experience sharp pain with every breath, or other long-term sequelae such as reduced respiratory function.
To overcome these limitations, Professor Jung devised a world-first approach in 2022. Instead of entering between the ribs, the surgical robot is inserted through an opening created beneath the lowest rib. This route navigates an area devoid of these specific nerves, fundamentally avoiding injury. The method utilizes the extended reach and free-rotation capabilities of modern surgical robots to perform precise resections, even when the distance to the lung is greater. This innovative approach is now being adopted by surgical teams in the United States, Canada, and other nations.
Proven Safety and Metastasis Detection
To verify the technique's efficacy, the research team conducted a clinical study from June 2022 to June 2025. The analysis of the 102 patients revealed a high safety profile, with severe complications occurring in only two cases (1.9%). Notably, there were no instances of diaphragmatic injury, a common concern for subcostal approaches. Furthermore, pseudohernia—a bulging of the abdomen caused by abdominal wall muscle paralysis that occurs in approximately 7.6% of conventional surgeries—was entirely absent, confirming the successful preservation of the intercostal nerves.
The technique also proved highly effective for lymph node dissection, a critical component of cancer staging and treatment. In an analysis of 47 patients at high risk of metastasis, the team successfully removed an average of 20.4 lymph nodes per patient. Significantly, in 23.4% of these cases, the surgery identified occult lymph node metastases that had not been detected by preoperative CT or PET-CT scans.
"This study is highly meaningful as it demonstrates that intercostal-sparing robotic surgery can dramatically reduce postoperative pain while maintaining a level of lung resection and lymph node dissection comparable to existing methods," said Professor Jung. "Moving forward, we will continue to analyze the long-term effects on respiratory function preservation and overall patient quality of life."
