Consoler and Bedside Surgeon Fused Uniportal Robotic-Assisted Thoracoscopic Surgery

Background: Uniportal thoracoscopic surgery for lung cancer has been rapidly increasing in Japan, and is now recognized as an option for minimally invasive surgery.Meanwhile, we have developed a "fused robotic-assisted thoracoscopic surgery (RATS)" approach, in which the bedside surgeon retracts the lung and performs stapling of the pulmonary vasculature and bronchus.To date, we have performed over 700 cases using this method.Therefore, by combining this fused technique with the uniportal approach, we introduce a console and bedside surgeon-coordinated uniportal RATS technique and elaborate on its operative outcomes.Methods: The da Vinci Xi Surgical System was used, with specific configurations for right-and left-side operations.A working port measured 4 cm was placed in the sixth or seventh intercostal space along the middle axillary line.In the right-side configuration, Arm 1 was deactivated; Arm 2 was used for the camera, Arm 3 for the left-hand instrument (fenestrated bipolar forceps), and Arm 4 for the right-hand instrument (SynchroSeal).A table surgeon was positioned on each side of the patient to retract the lung and perform suction or coagulation using a suction coagulator, thereby maintaining a clear operative field.When stapling the pulmonary vasculature and bronchus, one robotic arm was lifted from the port, creating space for the easy insertion of a manual stapler through the working port.Results: A total of 15 cases were performed using this approach.Lobectomy was performed in 13 patients and segmentectomy in 2. The average operation time was 153 minutes, and the postoperative course was uneventful in all cases.Conclusion: By combining a console-and table-surgeon-coordinated fused RATS approach with the uniportal technique, we were able to perform uniportal RATS safely.