Outcomes of 102 Patients Who Underwent Robotic-Assisted Thoracoscopic Surgery Pulmonary Resection via the Subcostal Approach

Background:In 2022, we implemented the subcostal approach using the da Vinci robotic surgical system.This study analyzes the operative outcomes and immediate follow-up results of subcostal robot-assisted thoracic surgery (subRATS).Methods: A total of 102 patients underwent subRATS pulmonary resection from 2022 to 2024 at our institution.We collected and analyzed clinical characteristics, intraoperative outcomes, short-term complications, and postoperative pulmonary function.A cumulative sum (CUSUM) model was used to assess the learning curve.Results: The mean age was 63 years, with 45.0% (46/102) of patients being male.Lobectomy was performed in 90.2% (92/102) of patients and segmentectomy in 9.8% (10/102).Regarding pathology, 96.0% (98/102) of patients had lung cancer, 2.0% (2/102) had a lung abscess, 1.0% (1/102) had a pulmonary arteriovenous malformation, and 1.0% (1/102) had pulmonary sequestration.The mean operation time was 15772 minutes.CUSUM analysis demonstrated a learning curve for operation time, indicating the reproducibility of subRATS pulmonary resection.Operative time significantly decreased with surgical experience (p<0.001).The mean estimated blood loss was 169375 mL.There was 1 case of in-hospital mortality due to postoperative myocardial infarction and 1 case requiring conversion to thoracotomy due to intraoperative bleeding.One patient developed postoperative chylothorax.The mean length of hospital stay was 43 days.The mean decrease in forced expiratory volume in 1 second was 409.4 mL at 1 month and 311.6 mL at 3 months postoperatively.No cases of postoperative diaphragmatic hernia were observed.Conclusion: SubRATS represents a novel access strategy for pulmonary resection that potentially leads to faster recovery.This study demonstrates its reproducibility and feasibility in clinical practice.Session 7