Biportal robotic-assisted surgery for lung segmentectomies: a surgical technique overview

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted thoracic surgery (RATS) has advanced minimally invasive procedures.
• Traditional multiport RATS and uniportal RATS (U-RATS) have limitations.
• Biportal RATS (Bi-RATS) balances benefits, reducing trauma and improving ergonomics.

Purpose of the Study:

• To provide a comprehensive overview of Bi-RATS for lung segmentectomies.
• To detail patient positioning, port placement, and intraoperative techniques.
• To highlight the role of advanced imaging in Bi-RATS.

Main Methods:

• Overview of biportal robotic-assisted thoracic surgery for lung segmentectomies.
• Description of patient positioning and port placement strategies.
• Integration of near-infrared fluorescence (ICG) and 3D CT reconstruction.

Main Results:

• Bi-RATS offers improved instrument maneuverability and ergonomic stapler trajectory.
• Anterior port placement may reduce postoperative pain by minimizing nerve compression.
• Robotic stapling minimizes manual stapler use and lung manipulation.
• ICG fluorescence enhances precise identification of segmental planes.

Conclusions:

• Bi-RATS optimizes robotic thoracic surgery by enhancing efficiency and minimizing access trauma.
• Enhanced recovery after surgery (ERAS) protocols contribute to faster patient recovery.
• Further research is needed on long-term outcomes, cost, and training standardization.