Fully uniportal robotic-assisted lobectomy using da Vinci Xi system: surgical technique for a fifth intercostal approach with the cross-arm technique.

Uniportal robotic-assisted thoracic surgery (U-RATS) has gained increasing attention as a further evolution of minimally invasive thoracic surgery. However, the da Vinci Xi system was originally designed for multi-port procedures, and its application in a uniportal setting presents technical challenges, including robotic arm interference and difficulty in stapler manipulation. Although dedicated single-port robotic platforms have been developed, their adoption remains limited. We present a modified uniportal robotic-assisted lobectomy technique using the widely available da Vinci Xi system. This approach combines a single-incision fifth intercostal access with the cross-arm technique to minimize arm interference and enable safe, surgeon-controlled robotic stapling. Optimized arm configuration allows stable visualization and effective manipulation within a single incision. In our experience of 120 consecutive cases, this technique was safely performed with acceptable perioperative outcomes. The median operative time and blood loss were within acceptable ranges, and conversion to thoracotomy or video-assisted thoracic surgery (VATS) was required in a limited number of cases. Postoperative recovery was generally favorable, with early mobilization and a short hospital stay. Without requiring a dedicated single-port robotic platform, this approach offers a practical and reproducible option for uniportal robotic lobectomy. This technique may facilitate broader adoption of U-RATS, particularly in institutions already equipped with multi-port robotic systems.