Chronic Neuralgia After Single‐Port Versus Multiport Trans‐Subxiphoid Robotic Mediastinal Surgery: A Prospective Single‐Arm Pilot Study With Historical Controls

PURPOSE: To compare postoperative pain and chronic neuralgia between single-port (SP) and multiport (MP) trans-subxiphoid robotic approaches in patients with anterior mediastinum disease. METHODS: In this prespecified secondary analysis of a prospective trial, we compared pain outcomes of patients undergoing SP trans-subxiphoid robotic surgery for anterior mediastinal disease with those of a historical MP cohort. Acute pain intensity was assessed using the Numeric Rating Scale (NRS) on postoperative days 0, 1 and 2, and at discharge. Chronic neuralgia at 6 months was evaluated with the PainDetect Questionnaire (PDQ). RESULTS: Chronic neuralgia occurred in 6.7% (1/15) of the SP group versus 38.9% (7/18) of the MP group (p = 0.081). Most neuralgia cases in the MP group (6/7) involved multiple domains, whereas the single SP patient experienced only one symptom. CONCLUSIONS: SP trans-subxiphoid robotic surgery demonstrated comparable perioperative pain with significantly lower risk of chronic neuralgia. TRIAL REGISTRATION: This study represents a prespecified secondary analysis of a prospective clinical trial (ClinicalTrials.gov identifier: NCT05455840).