Initial experience with and surgical outcomes of da Vinci single-port system in general thoracic surgery

Abstract

Background:The da Vinci single-port system (SPS) (Model SP1098, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been used in genitourinary and general surgical procedures; however, its clinical application in general thoracic surgery has not been attempted. This retrospective study investigated the clinical outcomes of SPS in general thoracic surgery.Methods: After approval from the Ministry of Food and Drug Safety in Korea, the surgical details of SPS in simple thoracic surgeries at two independent institutions were collected and retrospectively reviewed.Results: Overall, 17 surgeries were performed using SPS without conversion to multiport surgery. The patients included six males, and the overall median age was 52 years (range, 28-83 years). The commonest pathological diagnoses were thymoma (8 cases) and benign cystic lesions (6 cases). The approach for SPS was subxiphoid, subcostal, and intercostal in 11, 4, and 2 cases, respectively. All patients underwent the surgeries without complications. The median operation time and peak pain score were 120 minutes (range, 58-250 minutes) and 3 (range, 2-4). The median duration of in situ chest tube and hospital stay was 1 day (range, 1-2 days) and 3 days (range, 2-7 days), respectively. SPS showed a shorter duration of in situ chest tube and hospital stay than robotic single-site surgeries. Conclusions:The application of SPS in the field of general thoracic surgery is feasible and can be successful. Although this study reported preliminary data and the cases were relatively simple, advanced and complex procedures should be attempted with the SPS in the near future.

Multi-institutional surgical outcomes of robotic single-port surgery: a Korean experience

“…Particularly, access to the upper poles of the thymus could be possible, suggesting that subxiphoid approaches using SPS could be applied for complete thymectomy, whereas approaches for the bilateral lower poles were limited (Figure 1). In our previous reports, one of the limitations of using SPS is maintaining carbon dioxide (CO 2 ) insufflation preoperatively (9). We mainly used a third-party port designed for SP thoracoscopic or laparoscopic surgery Peak pain score during the admission 3.1±1.1 [1][2][3][4][5][6] SD, standard deviation.…”

“…The approaches and patients’ positions for SPS surgery were chosen according to each surgeon’s preference. The details of port placement were described in a previous paper ( 9 ). Postoperatively, the pain was assessed using a numeric pain intensity scale; the score was recorded by nurses every 8 hours until discharge ( 10 ), and the highest score during the admission periods was analyzed.…”

“…However, due to its innate limitations, SPS has not widely spread in the fields of general thoracic surgery; due to the thickness of the cannula, the approaches to the lesions in the thoracic cavity, which is surrounded by rib cages, are limited, and SPS requires a 10-cm distance between the tip of the cannula and the target anatomy to triangulate the instruments and enable complete articulation of both the elbow and wrist instrument joints ( 7 , 8 ). To overcome these limitations, the applications of SPS in general thoracic surgery, particularly for mediastinal mass excision, were reported in the previous literature ( 9 ). In addition to the aforementioned technical limitations, as of 2022, SPS is only approved in South Korea and cannot be applied in other countries, and reports outside South Korea have not been published.…”

Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases

“…The convergence of these two trends has resulted in a new single-port robotic system, the da Vinci Surgical System SP ® , designed for subxiphoid and subcostal thoracic approaches ( 35 ). Nowadays, it only has real value for anterior mediastinal lesions and thymectomy ( 36 ), while its use for lobectomy is still under development. We expect the integration of robotic staplers and the improvement of the SP platform to be ready in the near future.…”

Uniportal fully robotic-assisted major pulmonary resections

“…However, this development will take several years to be ready and reliable for thoracic surgeons, who are not normally familiarized with a subxiphoid approach. At this moment of writing, we can only say that from our experience, the SP platform is a good tool for thymectomies ( 22 ). For this reason, a good alternative to the SP is to learn the URATS technique with the available Da Vinci Xi system, using robotic staplers for a fully robotic approach.…”