A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer

Abstract

Minimally invasive techniques, typified by video-assisted thoracoscopic surgery, are widely practiced in the treatment of thoracic diseases all around the world, and video-assisted thoracoscopic surgery has been recognized as a standard treatment method for early staged lung cancer. Among them, roboticassisted thoracoscopic surgery, which has the advantages of providing a three-dimensional view and better maneuverability, has emerged as a next-generation technique in the field of minimally invasive surgery and is also gaining its popularity with the idea of Enhanced Recovery After Surgery deeply rooted in patients' minds. Up to now, robotic-assisted thoracoscopic surgery usually requires 3 or 4 ports with 1 or 2 additional access incisions. Meanwhile, traditional video-assisted thoracoscopic surgery can now be completed with uniportal method, with less postoperative pain and higher patient satisfaction with respect to the number of incisions in comparison with the multi-port technique. To inform the integration of these new minimally invasive techniques, here, we present a case in which uniportal right upper lobectomy was performed using the 4 th generation da Vinci Robotic Surgical System (Xi). With continuous innovation in robotic minimally invasive techniques and improvements in surgical skills, we believe more patients will benefit from roboticassisted thoracoscopic surgery with single port in the near future.

Early experience with uniportal robotic thoracic surgery lobectomy

“…However, the RATS technique is always described with three or four incisions plus a utility incision of 4 cm. This is certainly more invasive than the uniportal incision used in U-VATS ( 15 ), and uniportal RATS is exclusively a newborn technique that is growing nowadays ( 10 – 12 ).…”

“…The possibility of blending the uniportal approach with robotic technology would be an enormous improvement in terms of feasibility, safety, oncological outcomes, and enhanced postoperative recovery. An update of the literature during the revision process of our paper showed a very recent description of the technique (10, 11) and a previous case report (12). Thus, considering our personal experience with U-VATS and standard robotic techniques, we recently started our U-RATS program.…”

Uniportal pure robotic-assisted thoracic surgery—technical aspects, tips and tricks

“…Yang and colleagues described in 2021 a single incision for performing a right upper lobectomy using Da Vinci Robotic Surgery System Xi ® completed by instruments designed for VATS approach (dissector, grasper, suction, staplers), as a hybrid U-RATS-VATS (18). D e v e l o p i n g a n d i m p r o v i n g a s p e c t s o f U-RATS are:  Related to surgical technique, to identify and perfect new movements specific for uniportal robotic but different from U-VATS;  Robotic adaptations to an appropriate thoracic single port for vascular resection-either allowing the use of specifically designed staplers for U-RATS or eliminating the need for staplers by developing the vascular sealing devices for larger pulmonary vessels.…”

A retrospective comparative cohort study on the efficacy and safety of bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy

“…The reduction of the size of the robotic arm in the new generation da Vinci robotic XI surgical system enabled us to apply our surgical experiences of uniport VATS to RATS. A case report had demonstrated the feasibility of uniportal RATS ( 9 ). However, only 1 patient was involved in the report and the complex surgical techniques of uniportal surgery narrowed its application.…”