Clinics of Oncology

Research Article ISSN: 2640-1037 Volume 7

Research Hotspots and Frontiers of Robot-Assisted Thoracic Surgery: A Study Based

on Bibliometric Analysis
Wenjing Yang1, Yaopeng Wang2, Jincheng Yang1 and Ranran Du3*
1
Cancer Diagnosis and Treatment Quality Control Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer
Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
2
Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), China
3
Health Technology Strategic Information Research Office, Institute of Medical Information, Chinese Academy of Medical Sciences,
China
Received: 15 Apr 2023 Copyright:
*
Corresponding author:
Accepted: 20 May 2023 ©2023 Ranran Du, This is an open access article dis-
Ranran Du,
Health Technology Strategic Information Research Published: 16 Sep 2023 tributed under the terms of the Creative Commons Attri-
Office, Institute of Medical Information, Chinese J Short Name: COO bution License, which permits unrestricted use, distribu-
Academy of Medical Sciences, #3 Yabao Rd, tion, and build upon your work non-commercially.
Haidian District, Beijing, 100020, P.R. China

Citation:
Keywords: Ranran Du, Research Hotspots and Frontiers of Ro-
bot-Assisted Thoracic Surgery: A Study Based on Bibli-
Robot, thoracic surgery, Bibliometric,
ometric Analysis. Clin Onco. 2023; 7(1): 1-7
VOSviewer, CiteSpace

1. Abstract 1.4. Conclusion: The US is in a leading position in research in

1.1. Purpose: To analyze the research status and development this field, and the quality of research in China needs to be further
trend of robot-assisted thoracic surgery, to dig deeper into the re- improved. Robot-assisted thoracic surgery for cancer treatment is
search of robotic systems, and to provide reference for the appli- a research hotspot. The establishment of a clinical database for
cation of domestic robotic systems in the field of thoracic surgery. robot-assisted thoracic surgery and randomized controlled studies
are needed to improve. The quality of life of patients is the frontier
1.2. Methods: The publications from 2000 to 2019 were retrieved
of research in this field.
from the Web of Science Core Collection database. VOSviewer,
and CiteSpace software were used to analyze the publication out- 2. Introduction
comes, citation frequency, countries and institutions cooperation, The Da Vinci robot was certified by the U.S. Food and Drug Ad-
keywords and emergent words. ministration (FDA) in 2000 and is currently the most advanced
1.3. Results: A total of 1102 articles of statistical analysis were minimally invasive surgical robot system which integrates many
included. The top 5 countries for publishing articles were the Unit- emerging disciplines to achieve the development of minimally
ed States (US, 478 articles), China (123 articles), Germany (93 invasive, intelligent and digital surgical operations [1]. The op-
articles), Italy (80 articles) and Japan (65 articles). The citation eration of chest surgery applied to this system was approved by
frequency of the article in China is 5.29 times (0.00-9.13), which the U.S. FDA in 2001. After 20 years of clinical practice, it has
is lower than the world average of 15.71 times (1.89-22.59). Key effectively solved the two-dimensional surgical field of vision in
words in this field include “lung cancer”, “esophageal cancer”, conventional thoracoscopic surgery, the “chopstick” operation of
“lobectomy”, “esophagectomy”, “thymectomy”, “robot surgery”, rod-shaped instruments, and the long learning curve, lack of tac-
“minimally invasive surgery”, “thoracic surgery”, etc. Emergent tile feedback and other issues [2]. This study adopts bibliometrics
words are “cardiopulmonary bypass”, “axillary approach”, “rand- methods to analyze research papers in the field of thoracic surgery
omized controlled trial (RCT)”, “database”, “quality of life” and by robots in the Web of Science database. The research status and
so on. development trend of robot-assisted thoracic surgery are analyzed
from the perspectives of number of papers, national/regional dis-
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tribution and cooperation, research status, research hotspots and U S articles was 18.57(1.00-36.29) times, which has been basical-
frontiers, and the research on robotic systems is deeply explored to ly above the world average level from 2007 to 2019The cumula-
provide a reference for the application of domestic robotic systems tive average citation frequency of articles published in China from
in the field of thoracic surgery. 2007 to 2019 was 5.29 (0.00-9.13) times, which was lower than
3. Methods the same period average level of worldwide.

3.1. Data Source The spatial distribution map of national cooperation on robotic-as-
sisted thoracic surgery research was shown in Figure 4. The size of
The data was retrieved through the Web of Science database from
the circle represented the amount of published researches, and the
January 2000 to December 2019 with English language restric-
connected lines represented the frequency of cooperation among
tions. The search terms “robot” and “thoracic surgery” were found
different countries. The US (116 times) had the most connected
with this specific combination. In this study, we excluded confer-
lines with other countries, followed by Germany (63 times), Italy
ence papers, letters, comments, duplicate papers, irrelevant papers,
(55 times), Netherlands (54 times) and the United Kingdom (UK,
or papers with incomplete information
44 times). China ranked Number 10 with27 times cooperation with
3.2. Data Analysis other countries worldwide (Supplement Table1).
The Thomson Data Analyzer software (TDA) was used for data There were 1,102 papers in the field of robotic-assisted thoracic
cleaning and bibliometric analysis on basis of the retrieved arti- surgery, covering a total of 15,176 cited references. Cited papers
cles. The software VOS viewer and CiteSpace were used for visual were imported into the VOS viewer software for co-citation clus-
analysis. Through the establishment of time distribution map, na- tering and visualization (Figure 5), and a total of three types of
tional cooperation distribution map, institutional cooperation dis- knowledge bases were obtained. The first category was the com-
tribution map and keyword time zone map.etc, the knowledge base parison of the safety and postoperative recovery of robotic pneu-
and research hotspots in the field of robot-assisted thoracic surgery monectomy and thoracotomy and conventional thoracoscopic lung
were identified and found. CiteSpace software was used to analyze resection. The second category was the comparison of the short-
the emergent words to detect the rapid growth of professional vo- term benefits after robotic esophagectomy and thoracotomy eso-
cabularies in a short time. With the time distribution and dynamic phagectomy. The third category was the feasibility of the technical
change characteristics of emergent words, it reflected the research operation of the robot-assisted thoracic surgery system. Keywords
frontier and development trend of this field. are the author’s refinement of the core research content. Cluster
4. Results analysis of high frequency keywords could condense research hot-
A total of 1,209 pieces of data were retrieved in the Web of Science spots in a field. According to the strength of association, the top 20
database from January 2000 to December 2019, and 107 articles high frequency keywords are shown in Table 2.
due to not meet the inclusion criteria were excluded. Finally, 1,102 The generated high-frequency words co-occurrence matrix was
papers were included in the statistical analysis. As shown in Figure imported into VOS viewer for clustering and visualization, and
1, among the 1,102 articles, the top five countries for published the clustering results are obtained. Five research hotspots were
articles were the US (478), China (123), Germany (93), Italy (80) obtained through clustering results analysis (Figure 5). The five
and Japan (65). The number of articles published by the US was research hotspots were perioperative safety and risk analysis of
the highest worldwide than that of other countries, accounting for robotic manipulators in minimally invasive surgery in thoracic
43.38%. surgery, evaluation of short-term clinical efficacy of robot-assisted
As shown in Figure 2, in the past 20 years, the literature on ro- lobectomy compared with thoracotomy and conventional thora-
botic-assisted thoracic surgery research has been continued to coscopic surgery, robots experience sharing of assisted minimally
grow worldwide, especially from January 2014 to December2019, invasive esophagectomy and lymph node dissection, system man-
64.07% (706/1,102) articles were published in this period. The re- agement of robot-assisted surgical resection of thymic diseases
search trend of the US in this research field was similar with the and analysis of postoperative results, and complications and learn-
overall development trend of the world. However, the research of ing curves in the application of CT-navigated surgical robots.
robot-assisted thoracic surgery has been published in China until Using the word frequency increase algorithm provided by
2007. Citespace software, the words with high word frequency change
The citation frequency of an article reflects the quality of the arti- rate were detected from a large number of keywords and arranged
cle. As shown in Figure 3, the cumulative average citation frequen- according to the time when the emergent words appear to observe
cy of each article in the world from 2000 to 2019 was 15.71(1.89- the frontier and development trend of the robotic thoracic surgery
22.59) times, and the cumulative average citation frequency of the research field. According to the time span and emergence intensity,
the top 10 emergent words are shown in Table 3.

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Figure 1: The proportion of the researches on robot-assisted thoracic surgery in different countries from January 2000 to December 2019.

Figure 2: The number of published papers researched on robot-assisted thoracic surgery in each year from 2000 to 2019

Figure 3: The citation frequency of researched on robot-assisted thoracic surgery in China, the US and worldwide.

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Figure 4: The spatial distribution map of national cooperation on robot-assisted thoracic surgery

Figure 5: Research hotspots of robot-assisted thoracic surgery

Table 1: Top 10 countries in international cooperation frequency

Number Country Cooperation Frequency
1 The US 116
2 Germany 63
3 Italy 55
4 Netherlands 54
5 The UK 44
6 France 36
7 Switzerland 34
8 Belgium 31
9 Australia 28
10 China 27

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Table 2: The top 20 keyword strengths of robot-assisted thoracic surgery

No. Keywords Frequency Correlation strength
1 Outcomes 182 1138
2 Experience 202 1105
3 Resection 156 1030
4 Surgery 229 1004
5 Robotic surgery 163 843
6 Lobectomy 132 785
7 Cancer 136 761
8 Minimally invasive esophagectomy 87 565
9 Lung cancer 81 547
10 Minimally invasive surgery 90 518
11 Thoracotomy 63 464
12 Thoracoscopic lobectomy 60 407
13 Assisted thoracic-surgery 57 392
14 Thoracic-surgery 66 368
15 Robotic 64 365
16 Esophagectomy 55 362
17 Cell lung-cancer 53 352
18 Robotics 71 336
19 Esophageal cancer 50 326
20 thymectomy 50 321

Table 3: Emergent words in the research field of robot-assisted thoracic surgery

No. Keywords Strength Start Year End Year 2010 - 2019
1 cardiopulmonary bypa 2.74 2010 2014 ▃▃▃▃▃▂▂▂▂▂
2 axillary approach 3.2 2010 2012 ▃▃▃▂▂▂▂▂▂▂
3 myasthenia gravi 2.61 2010 2011 ▃▃▂▂▂▂▂▂▂▂
4 quality of life 3.08 2011 2014 ▂▃▃▃▃▂▂▂▂▂
5 thoracoscopic thymectomy 2.51 2013 2014 ▂▂▂▃▃▂▂▂▂▂
6 randomized controlled trial 3.11 2014 2017 ▂▂▂▂▃▃▃▃▂▂
7 open thoracotomy 2.55 2014 2016 ▂▂▂▂▃▃▃▂▂▂
8 thoracic surgical lobectomy 3.06 2016 2017 ▂▂▂▂▂▂▃▃▂▂
9 esophageal neoplasm 2.4 2016 2017 ▂▂▂▂▂▂▃▃▂▂
10 database 3.32 2017 2019 ▂▂▂▂▂▂▂▃▃▃

5. Discussion many advantages in the thoracic cavity, including benign and ma-
5.1. The research of robot assisted thoracic surgery in the Unit- lignant esophageal surgery, mediastinal mass resection, the rare
ed States has maintained a leading position, while in Chinathe operations including diaphragm operation and reconstruction, and
research quality needs to be further improved and internation- pleura stripping, were feasible and effective in clinical practice [4].
al cooperation needs to be strengthened. The surgical robot system has developed four generations (stand-
According to the number of published articles and citation fre- ard, S, Si, Xi). In April 2014, the latest fourth generation Xi ro-
quency, it can be seen that the amount of published articles in the bot was released, which has the advantages of three-dimensional
United States was much higher than that of other countries, and high-definition surgical field, flexible mechanical wrist and tremor
the quality of articles has been above the world average level since filter system [5], and has a qualitative improvement in flexibility,
2007. The Da Vinci robot was certified by the US FDA in 2000. In accuracy, imaging clarity, etc. The Da Vinci robot system has the
2002, robot-assisted lung surgery was reported for the first time. characteristics of a three-dimensional picture, a range of motion
The surgical procedures included lobectomy and wedge resection close to a human hand, and a movement of more than 360 degrees
[3]. Later, it was further explored that Da Vinci robot surgery has in a very small space (internal wrist technology) [6], which not
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only overcomes the shortcomings of conventional thoracoscopic of relieving pain, shortening hospital stay, reducing postoperative
surgery, but also retains the advantages of minimally invasive sur- complications and lung function damage [14], and robotic surgery
gery, such as small trauma, fast recovery and short hospital stay. has certain advantages in increasing the number of lymph node
Moreover, studies have proved that robot surgery has more ad- dissections and stations [15]. Certainly, compared with conven-
vantages than conventional thoracoscopic surgery in lymph node tional minimally invasive surgery and thoracotomy, the operation
dissection, high difficulty and high risk thoracic surgery, which cost was significantly increased, which was also an important fac-
reduces the difficulty of surgery and allows surgeons to complete tor limiting robotic surgery [2]. However, there were few reports
the operation more comfortably [2]. Since 2007, some articles on the comparison of the long-term effects of patients. Whether
have been published in the field of robotic surgery in China, which there is a difference between the five-year overall survival rate and
started later than foreign countries [7]. There is also a large gap the five-year disease-free survival rate remains to be seen [13, 16].
between the citation frequency of Chinese articles and the world 5.3. Robot-assisted surgical treatment of esophageal tumors
average level so that the quality of research needs to be further im- has a good prospect. The establishment of a clinical database
proved. The frequency of international cooperation is only in the of robot-assisted thoracic surgery, and the development of ran-
10th place. Compared with other top 10 countries in the number domized controlled studies to improve the quality of life of pa-
of published articles, China has less cooperation between counties. tients are the frontier research directions in this field.
In the future, it is necessary to further strengthen international co-
From the analysis of emergent words, it can be found that future
operation and exchange, learn from foreign advanced experience
research will mainly focus on two directions. Firstly, in terms of
and technology, and improve the research level of domestic arti-
treatment of diseases and surgical techniques, diseases such as tu-
cles. Meanwhile, the advantages of domestic surgical technology
mors in the esophagus, lung and thymus, myasthenia gravis, and
will be displayed to the world to increase China’s international
other diseases are still research hotspots. Robotic surgery will con-
influence.
tinue to be used in surgical applications such as esophagus, lung
5.2. Robot-assisted thoracic surgery for cancer treatment is a lobes, and thymectomy. Surgical approaches such as “cardiopul-
research hotspot, with particular attention to the sharing of monary bypass” and “axillary approach” are still research hotspots
surgical experience and the evaluation of perioperative surgi- in the future, especially, and robot-assisted surgical treatment of
cal results. esophageal tumors is the frontier of research. Robotic technolo-
Through keyword analysis, it can be seen that robot-assisted sur- gy has been applied to the surgical treatment of esophageal tu-
gery was used for research in the field of cancer. Commonly used mors in the early stage [17]. With the development of robotics,
in the surgical treatment of “lung cancer”, “esophageal cancer” robotic surgery has been skillfully applied in the surgery of the
and mediastinal tumors, “lobectomy”, “esophagectomy”, and neck, thoracic cavity and abdominal cavity [18, 19], which has
“thymectomy” were common surgical procedures for radical tu- laid a foundation for robot assisted surgical treatment of esoph-
mor surgery and appeared as keywords many times, which indicat- ageal tumor. At the same time, compared with open surgery, the
ed the treatment of cancer was the research hotspot of robotic tech- clinical outcome of robot-assisted esophageal surgery was bet-
nology in thoracic surgery. The research of robot-assisted thoracic ter, the incidence of surgery and cardiopulmonary complications
surgery mainly focused on two aspects. On the one hand, it focused was reduced, the pain was less, and the functional outcome was
on sharing experience with robotic surgery. Thoracic surgery had a also improved [20]. Robot-assisted esophagectomy has advantag-
narrow operating space and was close to important organs. In sur- es in ensuring clean margins, R0 resection rate of lymph nodes,
gical operations, it was necessary to perform fine anatomy of blood and thoracic anastomotic leakage [15]. Therefore, robot-assisted
vessels and other parts so that robotic technology was very benefi- surgical treatment of esophageal tumors is the frontier direction
cial [8]. According to different types of thoracic surgical diseases, of research. Secondly, to establish a database for robot-assisted
different postures and approaches were selected for preoperative thoracic surgery, to carry out randomized controlled studies, and
evaluation, and the application of manipulators, surgical operation to emphasize the improvement of patients’ quality of life and the
and other precautions were shared [9]. Some studies believed that, long-term effect of surgery, which is an important direction for
especially for esophageal surgery, because it involved multiple im- future research. From the analysis of hot spots, it can be found that
portant anatomical parts of neck, chest and abdomen, compared at present, the research on improving the quality of life of patients
with multiple incisions of conventional surgery, robotic surgery with robot-assisted thoracic surgery was mostly retrospective re-
was more attractive [10]. It also included research on learning and search or experience sharing [4]. With the accumulation of expe-
training of robotic surgery [11]; On the other hand, comparing the rience in robotic surgery, a complete database such as the national
recent results of “robotic surgery” with conventional “minimally database of American Society of thoracic surgeons was established
invasive surgery” and “thoracotomy surgery” [12, 13], domestic [21]. Randomized controlled studies of robotic surgery and open
and foreign scholars have basically reached a consensus in terms thoracic surgery and traditional minimally invasive surgery in lung
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cancer and esophageal cancer [19, 22, 23] can effectively improve 15. van der Horst S, de Maat MFG, van der Sluis PC, Ruurda JP, van
the quality of life of patients. In addition, some randomized con- Hillegersberg R. Extended thoracic lymph node dissection in robot-
trolled studies focusing on recent clinical outcomes and long-term ic-assisted minimal invasive esophagectomy (RAMIE) for patients
survival are ongoing [24, 25], which will provide strong evidence with superior mediastinal lymph node metastasis. Ann Cardiothorac
for the advantages of robotic surgery and will be the frontier of Surg. 2019; 8(2): 218-25.

future research. 16. Wei S, Chen M, Nan C, Liu L. Feasibility and safety of robot-assist-
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