High-intensity theatre lists for robot-assisted thoracic resection: a proof-of-concept series

The high-intensity theatre (HIT) list model improves elective surgical throughput by eliminating inter-case turnaround time through parallel anaesthetic preparation. Its application to major anatomical thoracic resection has not previously been described. Two prospective high-intensity theatre lists were conducted at a high-volume tertiary centre as a service evaluation between March and May 2025. The workflow protocol was agreed before any patient was booked. Fifteen consecutive eligible patients underwent robot-assisted thoracic surgery for anatomical lung resection using the da Vinci Xi platform; no screened patient was excluded after booking. Patients were pre-positioned in lateral decubitus in the anaesthetic room before entering theatre. Primary outcome was list completion rate; secondary outcomes included console time, turnaround time, complications graded by the Clavien-Dindo classification, length of stay, and 30- and 90-day mortality. List 1 comprised ten cases with two consultant surgeons operating simultaneously in two robotic theatres; List 2 comprised five cases with one surgeon. Briefing commenced at 07:30; knife-to-skin at 07:45. List 1 completed by 13:30 - ten major resections in 5 h 45 min - with actual turnaround of 2-3 min between cases. All 15 procedures were completed (list completion 100%). Median console time was 35 min (range 23-56). All resections achieved R0 status. Complications occurred in 5 of 15 patients (33%): three grade II, one grade IIIb, one grade IVa by the Clavien-Dindo classification. Median length of stay was 4 days (range 1-30). Thirty-day and 90-day mortality were nil. This is the first description of a HIT list for major anatomical thoracic resection. The model was feasible and did not raise unexpected safety concerns in this initial experience, delivering a marked increase in theatre throughput without expanding resource. Prospective multicentre evaluation is warranted before wider adoption.