Perioperative outcomes of extended robotic-assisted thoracic surgery with combined resection of adjacent structures

Extended robotic-assisted thoracic surgery (E-RATS) involving combined resection of adjacent structures remains uncommon, and consolidated reports are limited. This study aimed to describe our institutional early experience with E-RATS and evaluate perioperative outcomes, including the role of hybrid techniques.

We retrospectively reviewed a prospectively maintained database of patients who underwent planned E-RATS between January 2017 and October 2024. E-RATS was defined as robotic pulmonary resection combined with bronchoplasty, pulmonary arterioplasty, or resection of adjacent structures. A hybrid approach was defined as planned use of a small thoracotomy solely for pulmonary artery clamping and/or chest wall resection, with all other procedures performed robotically. Patients converted to full thoracotomy were excluded. Perioperative outcomes were analyzed descriptively.

Eighteen patients (1.4% of 1276 robotic resections) were included. Procedures comprised bronchoplasty (n = 9), pulmonary arterioplasty (n = 6), and combined resection of the chest wall, diaphragm, or pericardium. Median operative time was 255 minutes, and median blood loss was 10 mL. Major postoperative complications (Clavien-Dindo grade ≥III) occurred in 4 patients (22%). Postoperative pain was assessed using a numerical rating scale on postoperative day 1 and is reported descriptively. All resections achieved negative margins, and no 90-day mortality was observed.

In this single-institution early experience, extended robotic-assisted thoracic surgery, including selected hybrid procedures, was technically feasible and associated with acceptable perioperative outcomes. These findings provide descriptive and educational insight into the application of robotic-assisted techniques for selected complex thoracic resections.