Dual-portal robotic-assisted thoracic surgery (DRATS) as a reduced port RATS: early experiences in three institutions in Japan

Background: Robotic-assisted thoracic surgery (RATS) has gained increasing interest in recent years, with most procedures performed using the conventional multiportal approach. Uniportal RATS (URATS) approaches have recently been reported in the pursuit of minimally invasive procedures. However, URATS requires specific skills. Herein, we introduce dual-portal RATS (DRATS) performed with two incisions.Methods: Data of DRATS procedures performed from December 2022 to May 2023 were retrospectively reviewed. Twenty patients with lung cancer underwent anatomical lung resections via DRATS performed by our group at three institutes.Results: Among 20 cases of planned DRATS for anatomical pulmonary resections, there were no conversions to thoracotomy and no need for extra ports. The mean surgery time was 121 +/- 60 minutes and mean console time was 91 +/- 47 minutes. The mean intraoperative blood loss volume was 9.6 +/- 12.1 g. The mean duration of chest tube drainage and hospital stay were 2 +/- 1 and 5 +/- 2 days, respectively. The mean numerical rating scale for pain was 2 +/- 1 on the first postoperative day, 1 +/- 1 on the third day, and 1 +/- 1 at discharge. There were no postoperative complications or mortalities. Conclusions: Our primary experience shows that DRATS is safe and feasible for anatomical lung resection. We consider DRATS to be a very good preliminary step in the future transition to URATS.