Background: The da Vinci single‐port system (SPS) (Intuitive Surgical, Sunnyvale, CA, USA) was designed for single‐port (SP) surgery. Although we have reported our clinical outcomes using the SPS for a simple procedure in general thoracic surgery, major pulmonary resection had been performed only in cadaveric experiments to date. This study evaluated the feasibility of SP subcostal robotic major pulmonary resection using the SPS. Here, we present our initial clinical experience of SP subcostal robotic major pulmonary resection at our institution.Methods: Twenty‐five patients with lung cancer underwent SP major subcostal pulmonary resection using the SPS between March and November 2022. Patient characteristics, intraoperative and perioperative outcomes were assessed. Questionnaires were used to evaluate patient satisfaction with the cosmetic results and quality of life through face‐to‐face or telephone interviews on postoperative day 30.Results: All patients underwent major pulmonary resection with complete radical resection (R0). Nineteen patients underwent lobectomy, whereas six patients underwent segmentectomy. The mean docking time and total operative time were 4.16 ± 1.19 min (range, 2.3–7.8 min) and 197.6 ± 55.33 min (range, 130–313 min), respectively. No patients underwent conversion to open thoracotomy. One patient required an additional assistant port due to severe pleural adhesions.Conclusions: SP subcostal robotic major pulmonary resection using the SPS is feasible and safe. With the continuous development of robotic technology and surgical techniques, we believe that more complex general thoracic surgeries will be performed in the future using SPS.

Subxiphoid thymectomy is a novel alternative to the transthoracic approach and sternotomy, with potential benefits, such as reduced postoperative pain and faster recovery. We previously reported the initial experience with subxiphoid single-port robotic-assisted thoracic surgery (SRATS) thymectomy using the single-port robotic system (SPS). However, the efficacy of this technique remains unknown. Thus, this study examined the multi-institutional experience with SRATS thymectomy and compared the perioperative outcomes of this technique to those of subxiphoid single-port video-assisted thoracic surgery (SVATS) thymectomy. The data of patients who underwent subxiphoid SRATS and SVATS thymectomy, performed by three thoracic surgeons at three institutions between September 2018 and May 2024, were retrospectively collected. In total, 110 patients were included, with 85 and 25 undergoing SRATS and SVATS thymectomy, respectively. After propensity score matching, 25 patients were included in each group. The SRATS group was associated with a lower conversion rate to multi-port surgery (0% vs. 20%, p = 0.05), shorter chest tube drainage duration (1.32 ± 0.75 vs. 2.00 ± 1.29 days, p = 0.003), and a shorter postoperative hospital stay (2.52 ± 1.00 vs. 5.08 ± 5.20 days, p = 0.003). Subxiphoid SRATS thymectomy using the SPS is feasible and is a good alternative to conventional thymectomy. Further studies are necessary to confirm its benefits.

Jun Hee Lee, M.D., Jeong In Hong, M.D., Hyun Koo Kim, M.D., Ph.D.. J Chest Surg 2021;54:333-7. https://doi.org/10.5090/jcs.21.021

Jeong In Hong, M.D., Jun Hee Lee, M.D., Hyun Koo Kim, M.D., Ph.D.. J Chest Surg 2023;56:16-22. https://doi.org/10.5090/jcs.22.096

Jun Hee Lee, M.D., Jong Yun Won, M.D., Ji Eon Kim, M.D., Hee Jung Kim, M.D., Ph.D., Jae Seung Jung, M.D., Ph.D., Ho Sung Son, M.D., Ph.D.. J Chest Surg 2021;54:36-44. https://doi.org/10.5090/kjtcs.20.123

Jun Hee Lee, M.D., Jeong In Hong, M.D., Hyun Koo Kim, M.D., Ph.D.. J Chest Surg 2021;54:266-78. https://doi.org/10.5090/jcs.21.070