Surgical technical aspects of uniportal hybrid RATS and biportal pure RATS using a subcostal port

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Uniportal robotic-assisted thoracic surgery (RATS) evolved from multiportal RATS and video-assisted thoracic surgery (VATS).
• Uniportal pure RATS enables robotically controlled minimally invasive procedures.
• Technical limitations, such as stapler handling difficulties, restrict uniportal RATS indications.

Purpose of the Study:

• To present alternative surgical methods for overcoming uniportal RATS limitations.
• To describe techniques for uniportal hybrid RATS and biportal pure RATS.
• To address challenges in specific patient populations and complex anatomical dissections.

Main Methods:

• Uniportal hybrid RATS: placement of trocars in a triangular configuration and head-to-tail forceps manipulation.
• Biportal pure RATS: insertion of an additional subcostal port.
• Focus on avoiding trocar-robotic arm collisions and ensuring adequate distance to hilar structures.

Main Results:

• The described methods offer viable alternatives for patients unsuitable for uniportal pure RATS.
• Techniques facilitate complex procedures like middle lobectomy and lower lobe segmentectomies.
• Alternative port placement improves access and reduces potential complications.

Conclusions:

• Uniportal hybrid RATS and biportal pure RATS are effective alternatives to uniportal pure RATS.
• These approaches expand the applicability of robotic-assisted thoracic surgery.
• Careful technique and port placement are crucial for successful outcomes in challenging cases.