Modified open-thoracotomy-view approach in robotic-assisted thoracoscopic lung resection

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted thoracoscopic surgery (RATS) is a common thoracic procedure.
• The open-thoracotomy-view approach (OTVA) offers a wide view but has limitations.
• These limitations include robotic arm placement issues, suboptimal assistant port positioning, and the need for CO2 insufflation.

Purpose of the Study:

• To present modifications to the OTVA to overcome its limitations.
• To enhance surgeon operability and assistant performance in RATS lung resection.
• To introduce a modified 4-port, 3-arm OTVA technique.

Main Methods:

• Modification of the OTVA by repositioning a robotic arm into the lower intercostal space.
• Strategic placement of the assistant port between robotic arms.
• Elimination of the need for CO2 insufflation.
• Application of the modified technique in 20 lung resection cases.

Main Results:

• Enhanced surgeon operability due to improved robotic arm placement.
• Improved assistant performance with closer proximity to the hilum.
• Elimination of CO2 insufflation and associated closed port requirements.
• No critical issues observed in the initial 20 patient cases.

Conclusions:

• The modified OTVA enhances RATS lung resection by improving ergonomics for both surgeon and assistant.
• This technique offers a viable alternative without CO2 insufflation.
• Further evaluation in a larger patient cohort is warranted.