From central to peripheral: a novel robotic approach for lobectomy in patients with incomplete pulmonary fissures

Robotic-assisted thoracic surgery (RATS) is increasingly acknowledged for its efficacy in managing early-stage non-small cell lung cancer (NSCLC), owing to its distinct technical advantages. Nevertheless, individuals with pronounced incomplete interlobar fissures often face higher rates of conversion to alternative procedures and an increased likelihood of postoperative complications. This retrospective study introduces a novel robotic surgical technique tailored to the challenges posed by incomplete fissures, evaluating both its safety and therapeutic outcomes. A retrospective analysis was performed on the clinical data of individuals who received robotic-assisted lobectomy for NSCLC at our center from March 2021 to September 2024. Altogether, 554 cases were incorporated and divided into two cohorts-those with fully developed fissures and those with partially developed fissures-based on the anatomical features of their lung fissures. Among the 554 patients analyzed, 302 were categorized as having complete fissures, while 252 were identified with incomplete fissures. Comparative evaluation revealed no statistically significant differences between these groups in terms of operative duration (p = 0.411), intraoperative blood loss (p = 0.822), chest tube retention time (p = 0.733), rate of prolonged air leakage (PAL, p = 0.805), or postoperative hospital stay (p = 0.962). Importantly, neither group exhibited cases of bronchopleural fistula, pneumonia, or perioperative death. Incomplete fissures do not increase the procedural difficulty of lobectomy when employing this robotic surgical approach. This newly developed, robot-specific technique ensures both safety and efficacy for patients with incomplete fissures.