Single-Port Robotic Thoracic Surgery via Intercostal Approach: First Series from Turkey

Single-port (SP) robotic platforms aim to reduce surgical trauma by allowing all instruments through a single incision. In thoracic surgery, SP experience has been reported mainly via subxiphoid or subcostal routes, whereas the intercostal approach and heterogeneous case series remain scarce. We report an initial technical feasibility experience with intercostal SP robotic thoracic surgery, the first reported from Turkey.

This single-center retrospective review included the first 10 consecutive patients who underwent thoracic surgery with the da Vinci SP Surgical System via a standardized intercostal approach (single 2-4 cm incision at the midaxillary line, approximately the sixth intercostal space; March 13-April 28, 2026). Procedures comprised anatomic and wedge lung resections, esophageal surgery, and mediastinal/paraesophageal mass excision. This is presented as an initial technical experience rather than a comparative outcomes study; the primary endpoint was technical feasibility.

Ten patients (seven women and three men; mean age: 57 years, range: 44-68) underwent pulmonary resection (n = 5), esophageal surgery (n = 3), and mediastinal/paraesophageal mass excision (n = 2). All procedures were completed through a single intercostal incision, with no additional incision, no conversion, and no instrument clash. Mean operative time was 48.6 minutes (pulmonary/mediastinal) and 67 minutes (thoracic phase and esophageal); mean docking time was 4.4 minutes. Mean blood loss was 68 ± 32 mL, mean chest tube duration was 2.2 ± 1.3 days, and mean length of stay was 2.8 ± 1.4 days. Four patients underwent synchronous SP abdominal procedures. No complications, reinterventions, or 30-day mortality occurred.

In this small, highly selected initial series performed by an experienced team, intercostal SP robotic thoracic surgery appeared technically feasible across a range of thoracic procedures. Given the limited sample size and retrospective design, these findings should be regarded as hypothesis-generating; larger prospective studies are needed before conclusions regarding safety or comparative outcomes can be drawn.