Initial Experiences of Single-Port Robotic Segmentectomy Using the Single-Port Robotic System via a Subcostal Approach

Background: Single-port robotic-assisted thoracoscopic surgery (RATS) is an emerging minimally invasive approach for anatomic pulmonary resection.We previously reported our initial experience of RATS anatomical pulmonary resection using the single-port system.However, the feasibility of segmentectomy using this technique has not yet been validated.Therefore, this study aimed to evaluate the feasibility and safety of single-port robotic segmentectomy using the single-port robotic system via a subcostal approach.Methods: Between January 2023 and December 2024, a total of 48 patients underwent robotic segmentectomy using the single-port robotic system at a single center.Patient demographics, intraoperative outcomes, and postoperative outcomes including complications were retrospectively analyzed.Results: Among the 48 patients (mean age, 61.410.6 years), there were 20 males (41.7%) and 28 females (58.3%).Pathological diagnoses included adenocarcinoma in 34 patients (70.8%), squamous cell carcinoma in 4 (8.3%), and metastatic cancer in 10 (20.8%).The mean tumor size was 2.31.1 cm, and the mean operation time was 126.836.7 minutes.The median postoperative hospital stay was 4.0 days (interquartile range [IQR], 3.0-6.0),and the median chest tube duration was 2.0 days (IQR, 2.0-3.0).R0 resection was achieved in all patients (100%), with no conversions to thoracotomy.Major postoperative complications (Clavien-Dindo grade IIIb) occurred in 2 patients (4.2%), and there was no 30-day mortality. Conclusion:In the present study, we demonstrated the feasibility and safety of single-port robotic segmentectomy using a subcostal approach.This approach can serve as a viable alternative for anatomical segmentectomy.Although further large-scale studies are necessary to validate the efficacy of this technique, the potential of this approach remains highly promising, particularly with continued advancements in robotic systems.