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. 2023 Jan 31;12(1):34-40.
doi: 10.21037/acs-2022-urats-140. Epub 2022 Dec 30.

Hybrid uniportal robotic-assisted thoracoscopic surgery using video-assisted thoracoscopic surgery staplers: technical aspects and results

Haoran E #  1 , Chenlu Yang #  1 , Jun Wu #  1 , Junqi Wu  1 , Long Xu  1 , Tao Wang  1 , Lei Zhang  1 , Gening Jiang  1 , Yuming Zhu  1 , Chang Chen  1 , Deping Zhao  1
Affiliations

Hybrid uniportal robotic-assisted thoracoscopic surgery using video-assisted thoracoscopic surgery staplers: technical aspects and results

Haoran E et al. Ann Cardiothorac Surg. .

Abstract

Background: The clinical efficacy of robot-assisted thoracic surgeries has been explored by numerous recent studies. Nonetheless, since current standard robotic systems (da Vinci Xi system) were intended for multiportal surgical processes and robotic staplers were still unavailable in the developing world, obstacles still remain concerning the feasibility of uniportal robotic surgeries.

Methods: A hybrid uniportal robotic-assisted thoracoscopic surgery (RATS) modality utilizing video-assisted thoracoscopic surgery (VATS) staplers was investigated in Shanghai Pulmonary Hospital. Clinicopathological characteristics and perioperative outcomes concerning patients receiving hybrid uniportal RATS between August 2022 and September 2022 were collected.

Results: A total of 40 patients were included in this study. Most of the patients (23/40, 57.5%) received hybrid uniportal RATS lobectomies. One conversion from uniportal RATS to biportal process was encountered due to extensive adhesions discovered intraoperatively. The median procedural duration was 76 min [interquartile range (IQR), 61-99 min], and the median blood loss volume was 50 mL (IQR, 50-50 mL). A median stay length of three days (IQR, 2-4 days) was recorded. Eleven patients (27.5%) developed Clavien-Dindo grade I-II postoperative complications, while no grade III-IV complications were observed. Aside from this, none of the patients were readmitted or died within 30 days post-surgery.

Conclusions: The feasibility of hybrid uniportal RATS procedures using VATS staplers has been preliminarily validated. For early-stage non-small cell lung cancer patients, such a procedure might clinical efficacy comparable to that of uniportal RATS utilizing robotic staplers.

Keywords: Uniportal robot-assisted thoracoscopic surgery (U-RATS); hybrid surgery; minimally invasive surgery; non-small cell lung cancer (NSCLC); surgical stapler.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Hybrid uniportal RATS using VATS staplers. (A) The single intercostal incision made during the operation; (B) robotic arm placement: the camera arm was usually placed to the upper edge of the incision using arm 2, and forceps were afterwards placed close to arm 2 using arm 3. Electrocautery hook was then placed close to the lower edge of the incision by arm 4. Spaces between arms 3 and 4 would also allow the assistant to employ oval forceps or suction device; (C) the view of the operator during the hybrid uniportal RATS. RATS, robotic-assisted thoracoscopic surgery; VATS, video-assisted thoracoscopic surgery.
Figure 2
Figure 2
Operation durations of the hybrid uniportal RATS are chronologically presented. RATS, robot-assisted thoracoscopic surgery.
See this image and copyright information in PMC

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