Uniportal robotic‐assisted thoracoscopic surgery for early‐stage lung cancer with the Da Vinci Xi: Initial experience of two cases

Abstract

Background: Minimally invasive surgery (MIS) techniques, currently considered the gold standard in the treatment of early-stage non-small cell lung cancer (NSCLC), are mainly represented by video-assisted thoracoscopic surgery (VATS), both uniportal and multiportal, and by robotic-assisted thoracoscopic surgery (RATS). While multiportal RATS has been accepted as a valid alternative to VATS, carrying the advantages of three-dimensional high-definition visualisation and improved maneuverability, very few reports exist in literature on the application of uniportal RATS (U-RATS). Therefore, we describe our initial experience with this recently developed method in the treatment of early-stage NSCLC.Materials and Methods: U-RATS was conducted through a single 4 cm long anterolateral mini-thoracotomy (ALMT) in the sixth intercostal space at the mid-axillary line. Three 8 mm robotic trocars were positioned and connected, from back to front, to robotic arms as follows: 30°camera arm, robotic arm 2 (bipolar fenestrated grasper) and 1 (Maryland bipolar forceps). Assistant access was identified as the most anterior part of ALMT. Results: Case 1: an 82-year-old woman (American Society of Anaesthesiologists [ASA III]) underwent a left S6 segmentectomy for a clinical stage IA2 NSCLC, complicated by an air leak that resolved spontaneously by postoperative day three (POD 3). Case 2: a 75-year-old man (ASA III) underwent an uncomplicated right lower lobectomy for a clinical stage IA3 NSCLC. Case 1 and 2 were discharged on POD 5 and 4, respectively. Conclusions:From what emerged in our small series, U-RATS with the Da Vinci Xi surgical system might be considered a safe, reliable, and effective alternative to other MIS techniques. Larger prospective studies are required to validate these findings.

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.…”

Uniportal robotic assisted surgery for anatomical lung resection—First German experience

“…It may be cheaper, less painful, and allow easier management in case of emergency. 11 Apart from the group, that introduced the uniportal robotic approach, there have been very few publications on uniportal RATS, [12][13][14] and it remains uncertain whether this technique and teaching can be replicated and implemented in different settings by different surgeons. The purpose of this paper is to report our first experience with the uniportal robotic approach for anatomic lung resections performed by a single surgeon.…”