Uniportal robotic-assisted thoracic surgery for mediastinal tumor resection via the lateral intercostal approach: a surgical technique and our ingenuity.

Robotic-assisted thoracic surgery (RATS) has gained increasing interest in the last few years and is becoming more widely adopted worldwide thanks to significant technical advantages such as stereoscopic visualization, accurate and complex movements, camera stability, and a shorter learning curve compared to video-assisted thoracoscopic surgery (VATS). However, because robotic platforms are designed for four robotic arms, four to five incisions have been considered necessary for most thoracic approaches, which contrasts with the concept of minimal invasiveness. The blending of the uniportal approach with robotic technology would bring enormous improvements in safety, effective and postoperative recovery. Recently, uniportal RATS (URATS) approaches have been reported in the pursuit of minimally invasive procedures. However, specific skills are needed to perform URATS. Although there are increasing reports of URATS using the da Vinci single-port (SP) robot system for mediastinal tumor resection, there have been only a few reports detailing the surgical technique of URATS using the da Vinci Xi system. The da Vinci SP platform is too wide to use an approach via the intercostal space because of the 2.5 cm cannula. In the other hand, the da Vinci Xi platform is suitable to use an approach via the intercostal space because of the 8 mm cannula. Herein, we report the surgical technique of URATS using the da Vinci Xi system with innovative port placement. This surgical technique causes less intercostal invasive injury and is suitable for mediastinal tumor resection in hospitals that do not already have a da Vinci SP system. Our experience and literature suggest that URATS for mediastinal tumor procedures is safe and effective and should be considered as a valid additional surgical option.