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Non-assistant help operation in dual-portal RATS (neoDRATS): a surgical technique.

Hiroki Ebana¹, Aki Kobayashi¹

¹Department of Thoracic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.

Journal of Visualized Surgery

|June 11, 2026

Summary

A new dual-portal robotic-assisted thoracic surgery (RATS) technique, neoDRATS, overcomes challenges of uniportal RATS. This approach enhances safety and maneuverability for reduced-port procedures.

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Area of Science:

Thoracic Surgery
Robotic Surgery
Minimally Invasive Procedures

Background:

Robot-assisted thoracic surgery (RATS) advances focus on reduced-port techniques to minimize invasiveness.
Current uniportal RATS faces challenges like limited space and instrument interference, especially in smaller patients.

Purpose of the Study:

To introduce and describe a novel non-assistant help operation in dual-portal RATS (neoDRATS).
To demonstrate neoDRATS's ability to overcome limitations of uniportal RATS by fully utilizing the da Vinci Xi system's four arms.

Main Methods:

Development of neoDRATS, a dual-portal technique using a 4-cm main incision and a single auxiliary port.
Full utilization of all four da Vinci Xi arms for console-surgeon-driven lung retraction and robotic stapling.

Keywords:

Surgical technique dual-portal RATS reduced-port surgery (RPS)robot-assisted thoracic surgery (RATS)

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Step-by-step description of surgical technique, including patient positioning, port placement, and robotic arm configuration.

Main Results:

neoDRATS enables robotic lung retraction and stapling via a dual-portal setup.
Operative videos illustrate feasibility in right upper and left lower lobectomy.
The technique balances minimal access with operative safety and maneuverability.

Conclusions:

neoDRATS provides a practical reduced-port RATS approach preserving familiar surgical views.
Facilitates safe and reproducible adoption of reduced-port robotic thoracic surgery for pulmonary resections.
Bridges the gap between multiport RATS and uniportal techniques by combining stability with reduced invasiveness.