Port Placement Variations for Robotic Lung Resection: Focusing on Their History, Conventional Look-Up-View and Horizontal Open-Thoracotomy-View Techniques, and More

Abstract

This is a narrative review that summarizes the variations in approaches and port placements used for performing robotic lung resections on the da Vinci Surgical Platforms. Currently, the four-arm, look-up-view method, in which the intrathoracic cranial side is viewed from the caudal side, is considered the mainstream approach worldwide. Several variations were devised from this conventional technique, including the so-called horizontal open-thoracotomy-view techniques in which the intrathoracic craniocaudal axis is aligned with the horizontal direction of the console monitor, and fewer port and incision techniques. In September 2022, 166 reports were surveyed using a PubMed English literature search, and this review finally included 30 reports describing the approaches. We categorized the variations into four-phase groups considering advent histories: (I) early era, three-arm technique with utility incisions; (II) four-arm, total port technique without robotic staplers; (III) four-arm technique using robotic staplers; (IV) maximizing the functional features of the Xi, significant alterations in viewing directions, and reducing ports, including the ultimate uniport technique. To comprehensibly visualize these variations for practical use, we created elaborate illustrations based on the literature. The familiarity of thoracic surgeons with the variations and characteristics allows them to choose the optimal procedure that best suits each patient and their preferences.

Keywords: approach; history; port placement variation; robotic lung resection.

Figure 19

A modification of Cerfolio’s setting (T.E., Shinshu University, unpublished) [29,30].

Figure 1

Flow diagram for selecting reports.

Figure 2

Melfi et al.’s setting [1].

Figure 3

Ashton et al.’s setting [2].

Figure 4

Park et al.’s setting [3].

Figure 5

Gharagozloo et al.’s setting [4].

Figure 6

Veronesi et al.’s setting [5].

Figure 7

Ninan et al.’s [6] and Dylewski et al.’s [7] setting.

Figure 8

Cerfolio et al.’s setting [8].

Figure 9

Pearlstein’s setting [9].

Figure 10

Kim et al.’s [10] (R) and Khan et al.’s [11] (L) setting.

Figure 11

Yamazaki et al.’s setting [12,13].

Figure 12

Funai et al.’s setting [14].

Figure 13

Sakakura et al.’s setting [15,16].

Figure 14

Kang’s setting [17].

Figure 15

Ueda et al.’s setting [18].

Figure 16

Han et al.’s setting [19].

Figure 17

Yang et al.’s setting [20].

Figure 18

Gonzalez-Rivas et al.’s setting [21].