Uniportal robotic‑assisted thoracic surgery for anatomical lung resections: initial experience and technical...

Uniportal robotic-assisted thoracic surgery (URATS) combines the precision of robotic systems with the minimal invasiveness of single-incision surgery. However, its widespread adoption is currently limited by technical challenges regarding external robotic arm collision and setup complexity.

We aimed to evaluate the feasibility, safety, and early adaptation of URATS using a standardized "vertical parallel" docking strategy during our initial experience.

Data from the first 12 consecutive patients undergoing URATS anatomical lung resections were retrospectively analyzed. A strict vertical parallel docking configuration was employed, stacking the robotic arms linearly within the incision to prevent collision. The early learning trends were assessed using trend analysis of docking and console times.

The cohort included 7 lobectomies, 4 segmentectomies, and 1 pneumonectomy. All procedures were successfully completed without conversion to thoracotomy or multiportal RATS. Median total operative time was 211 minutes (range, 122-368 min). A rapid standardization of the setup phase was observed, with median docking time stabilizing at 5 minutes (range, 4-7 min). Correlation analysis demonstrated rapid adaptation to the setup process within the initial cases (Spearman ρ = -0.92; P <⁠0.001). Console times fluctuated according to patient-specific complexity (eg, obesity, adhesions) rather than case sequence. No major intraoperative complications occurred.

URATS is a safe and feasible technique for complex anatomical resections, including pneumonectomy, even during the initial experience. The adoption of a vertical parallel docking strategy may shorten the initial adaptation phase by preventing robotic arm collisions, thereby making the procedure more reproducible.