Hybrid uniportal robotic-assisted thoracoscopic surgery (RATS) using video-assisted thoracoscopic surgery (VATS) staplers: technical aspects and results

Background: The clinical efficacy of robot-assisted thoracic surgeries has been explored by numerous recent studies. Nonetheless, since current standard robotic systems (da Vinci Xi system) were intended for multiportal surgical processes and robotic staplers were still unavailable in the developing world, obstacles still existed concerning the feasibility of uniportal robotic surgeries.Methods: A hybrid uniportal robotic-assisted thoracoscopic surgery (RATS) modality utilizing video-assisted thoracoscopic surgery (VATS) staplers was exploited in Shanghai Pulmonary Hospital. Clinicopathological characteristics and perioperative outcomes concerning patients receiving hybrid uniportal RATS between August 2022 and September 2022 were collected.Results: A total of 40 patients were included in this study. Most of the patients (23/40, 57.5%) received hybrid uniportal RATS lobectomies. One conversion from uniportal RATS to biportal process was encountered due to extensive adhesions discovered intraoperatively. The median procedural duration was 76 min [interquartile range (IQR), 61-99 min], and the median blood loss volume was 50 mL (IQR, 50- 50 mL). A median stay length of three days (IQR, 2-4 days) was recorded. Eleven patients (27.5%) developed Clavien-Dindo grade I-II postoperative complications, while no grade III-IV complications were observed. Aside from this, none of the patients were readmitted or died within 30 days post-surgery.Conclusions: The feasibility of hybrid uniportal RATS procedure using VATS staplers has been preliminarily validated. For early-stage non-small cell lung cancer patients, such a procedure might harbor a non-compromising clinical efficacy to that of uniportal RATS utilizing robotic staplers.