Early experience with uniportal robotic thoracic surgery lobectomy

Abstract

BackgroundInvasiveness is considered one of the cornerstones of every field of surgery, and video-assisted thoracoscopic (VATS) approaches are now routinely used worldwide to perform pulmonary resections. Recently, robotic-assisted thoracic surgery (RATS) has become the preferred technique in many centers; it is routinely performed using three or four ports with at least one service incision, contrasting with the real concept of invasiveness, especially when compared to uniportal VATS (U-VATS). Hereby, we present our early experience with uniportal RATS (U-RATS) pulmonary resections for early-stage lung cancer. Technical details of surgical steps are accurately described and commented on.ResultsTwenty-four consecutive patients with lung cancer underwent U-RATS anatomical pulmonary resections at our institute. All procedures were completed with the uniportal approach. The mean operative time was 210 min (range 120–350); in the last 10 cases, the operative time was significantly reduced (180 min) compared to the first 10 cases (232 min) (p < 0.02), showing a very fast learning curve. The postoperative pain score was comparable to that for U-VATS and was constantly low.ConclusionsU-RATS is a safe and feasible technique, combining the advantages of U-VATS with the well-known advantages of robotic surgery.

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

“…When compared to hybrid uniportal robotic-assisted approach, we consider that our technique resolves the need to rely on the assistant for the critical steps of the surgery such as stapling and, mirroring the uniportal VATS approach, makes for a faster learning curve. Already the technique has gained interest, and similar results in terms of safety and surgical outcomes have been reported (17). The robotic approach has proven to be less invasive (18), thus allowing for a shorter hospital stay, and in our comparative groups, patients that underwent a uniportal approach had a faster discharge from hospital.…”

Transition from multiportal video-assisted thoracic surgery to uniportal video-assisted thoracic surgery… and evolution to uniportal robotic-assisted thoracic surgery?

“…The former is already coming true as the monopoly of the only RATS system manufacturer is coming to an end, and alternative, cheaper RATS systems are now emerging on the marketplace. The latter may also be coming true as an intrepid handful of surgeons have begun to experiment with a URATS approach for various types of lung resections, using a single intercostal incision, without rib spreading (62)(63)(64)(65). A robotic camera, robotic dissecting instruments and robotic staplers are used, without the need of a bedside assistant to handle any conventional VATS staplers and instruments (63,64).…”

“…At the time of this writing, all that the world knows is that a very small number of surgeons have performed an unspecified number of URATS operations (62)(63)(64). To date, only one group has reported a series of 24 URATS lung resections without mortality (65). There is as yet no further consistent documentation of the overall safety of the approach.…”

The perioperative outcomes of uniportal robotic-assisted thoracic surgeries—a systematic review and meta-analysis of surgical cohort studies and case reports

“…A total of 137 studies on the application of u-RATS were identified for inclusion, with 12 progressing to inclusion (5 cohort series, 7 case reports) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The cohort series are presented in Table 3.…”