Uniportal Robotic-Assisted Sleeve Resections in a High-Volume Centre: Technique and Results

This study aims to evaluate the safety and feasibility of uniportal robot-assisted thoracic surgery for sleeve lobectomy and to analyse the impact of induction therapy on perioperative outcomes.

Between January 2022 and June 2025, 134 consecutive patients who underwent uniportal robot-assisted thoracic surgery sleeve lobectomy using the da Vinci Xi system were enrolled from a prospective database. Perioperative variables, including patient characteristics, surgical details, pathologic outcomes, and 30-day complications, were analysed. Statistical comparisons were performed between patients who received induction therapy and those who did not.

The cohort had a median age of 62 years, with 72.3% having a smoking history. Squamous cell carcinoma was predominant (68.6%), and 55.2% of patients received induction therapy, primarily chemoimmunotherapy. The left upper lobe was the most common resection site (35.1%). R0 resection was achieved in 97.8% of cases. The median operative time was 185 min, and median hospital stay was 6 days. Patients underwent induction therapy was associated with longer operative time (202.5 vs 172.5 min, P = .005) and hospital stay (7 vs 6 days, P < .001) but did not significantly affect blood loss, conversion rate (9.5% vs 6.7%, P = .687), major complications (23.0% vs 26.7%, P = .622), or 30-day readmission (1.4% vs 3.3%, P = .441). There were no 30-day deaths.

Uniportal robot-assisted thoracic surgery sleeve lobectomy is technically safe and feasible, with high R0 rates and acceptable morbidity. Induction therapy prolongs operative time and hospitalization but does not significantly increase perioperative risk. These findings support the adoption of uniportal robot-assisted thoracic surgery for complex sleeve lobectomy, including patients after induction treatment.