Uniportal robotic‐assisted thoracoscopic surgery for early‐stage lung cancer with the Da Vinci Xi: Initial experience of two cases. Issue 1 (7th November 2022)

• Record Type: Journal Article
• Authors: Vincenzi, Paolo; Lo Faso, Felice; Eugeni, Emilio; Patriti, Alberto
• Is Part Of: International journal of medical robotics and computer assisted surgery. Volume 19:Issue 1(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-11-07
• Subjects: Da Vinci Xi -- lung cancer -- RATS -- robotic‐assisted thoracoscopic surgery -- thoracic minimally invasive surgery -- uniportal; Robotics in medicine -- Periodicals; Surgery -- Technological innovations -- Periodicals; Imaging systems in medicine -- Periodicals; 617.90285
• DOI: 10.1002/rcs.2477
• Languages: English
• ISSNs: 1478-5951

Abstract

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 antero‐lateral 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.