Improved complete portal 4-port robotic lobectomy for lung cancer: Hamamatsu Method KAI

Abstract

Robot-assisted thoracoscopic surgery (RATS) has been widely used in lung cancer surgery. We previously devised a new port arrangement for RATS for lung cancer, the "Hamamatsu Method", to provide good cranial field of view using the da Vinci Xi surgical system. Our method utilizes four robot ports and one assist port, while our video-assisted thoracoscopic lobectomy technique is performed with four ports. We believe the number of ports in robotic lobectomy should not exceed those in video-assisted thoracoscopic lobectomy to preserve the advantage of minimal invasiveness. Furthermore, patients are generally more sensitive to wound size and number than surgeons assume. Thus, by combining the access and camera ports of the "Hamamatsu Method", we devised the 4-port "Hamamatsu Method KAI", which is equivalent to the conventional 5-port method, while maintaining full functionality of all four robotic arms and the assistant. "Hamamatsu Method KAI" showed comparable safety as the conventional 5- or 6-port method. Our improved 4-port method ensures minimal invasiveness while maintaining the same feasibility as the original method. The novelty of this operative method is the combined camera/assistant/access incision, and this technique is an option for RATS for lung cancer. "KAI" is a Japanese suffix indicating a sequel or successor.

Keywords: Robot-assisted thoracoscopic surgery (RATS); non-small cell lung cancer; robotic lobectomy.

Figure 1

Port arrangement in the Hamamatsu Method KAI. Four robotic arms are docked to the four robotic ports. From the cranial side, they become the left hand (8-mm port), camera (30-mm access port), surgeon’s right hand for initial maneuvers (8-mm port), and surgeon’s right hand (to operate the retraction arm and stapler; 12-mm port).

Figure 2

An alnote^® lap single was attached to the 30-mm access port. An 8 mm port was passed into the lap single on the ventral edge of the access port for robotic arm 2. This was used for the camera.