Enhanced Trocar Design Optimizes Robotic-Assisted Lung Resection

Purpose This study aims to assess the initial experience with a downsized bevel-cut trocar to enhance lung resection in robot-assisted thoracoscopic surgery (RATS). In addition, we provide a mathematical model to support the scientific rationale and functional advantages of this design. Method We analyzed the impact of trocar cannula diameter using software and conducted a retrospective review of patients who underwent lung resection using a modified bevel-cut trocar for uniportal or biportal RATS between July 2024 and February 2025. Perioperative and postoperative outcomes, including incision length, surgery duration, complications, and hospital stay, were compared with those of conventional trocar RATS. Results A total of 34 patients underwent RATS anatomical lung resection, including 12 with modified bevel-cut trocars and 22 with conventional trocars. Baseline demographic and clinical characteristics were comparable between groups. The modified trocar group had shorter utility incision lengths than the conventional trocar group (overall p < 0.001). Mean incision length was 3.75 cm (range, 3.0–4.5) versus 6.0 cm for uniportal RATS and 3.0 cm versus 4.6 cm (range, 4.0–6.0) for biportal RATS. In exploratory approach-specific comparisons, operative time was shorter in the modified trocar group for both uniportal and biportal RATS (p = 0.007 and p = 0.039, respectively), whereas this finding should be interpreted cautiously because of the small subgroup sizes and non-randomized approach selection. No conversion, major postoperative complication, or mortality occurred. Conclusion The modified bevel-cut trocar offers a safer and more practical solution for performing uniportal or biportal RATS.