Report on 153 sequential three-incision robotic-assisted pulmonary resections by a single surgeon: technical details and learning curve

BACKGROUND: There are several techniques for robotic-assisted pulmonary resection, depending on the number and position of ports and utility incisions. We developed a technique for three-incision robotic-assisted pulmonary resection, and here we reported our initial results. METHODS: Three-incision pulmonary resection with the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was attempted in 153 patients. Robotic instruments were used for individual dissection of the hilar structures through two thoracoscopic ports and a 3-cm utility incision without rib spreading. Data on patient characteristics and perioperative results were prospectively collected. RESULTS: Between December 2016 and December 2018, a single surgeon performed three-incision robotic-assisted pulmonary resection on 153 consecutive patients in the Thoracic Surgery Department of the Second Xiangya Hospital. There was no emergent conversion to thoracotomy. Median operative time was 146.84 minutes (range, 40–320 minutes), and the median estimated blood loss was 62.70 mL (range, 5–200 mL). The mean postoperative days before chest tubes were removed was 3.91 (range, 2–18), and the mean postoperative days before patients were discharged was 5.34 (range, 2–20). The median number of lymph node stations dissected was 5 (range, 1–9). The mean number of nodes resected was 12 (range, 1–35), and postoperative complications were observed in 12 patients (7.84%). CONCLUSIONS: Three-incision robotic-assisted pulmonary resection is practicable, safe, and ideal for novices experienced in video-assisted thoracic surgery (VATS) surgery. It also appears to be oncologically acceptable for lung cancer; however, more studies on a large population are necessary to confirm these conclusions.