Technical feasibility and early outcomes of single-port robotic mediastinal mass resection through subxiphoid, intercostal, and subcostal approaches.

Robotic thoracic procedures can now be performed through a single incision using the da Vinci single-port (SP) system, which combines a flexible three-dimensional endoscope with articulating instruments in one platform. Although this platform has been increasingly used for anterior mediastinal surgery, particularly thymectomy, its role in other mediastinal compartments has not been well established. We reviewed our initial experience with SP robotic resection of mediastinal masses through three distinct access routes: subxiphoid, intercostal, and subcostal. We analyzed 64 consecutive patients who underwent SP robotic surgery for a mediastinal lesion between June 2021 and December 2025. For each patient, the entry route was planned after reviewing the lesion's compartment, dimensions, and the most suitable line of dissection. All 64 patients achieved complete resection without any case requiring conversion. Median console and total operative times were 89.5 and 125.5 min for thymectomy, and 51.0 and 84.5 min for mediastinal mass excision, respectively. No major intraoperative complications occurred. Postoperative chylothorax developed in two patients (3.1%), both of whom were managed conservatively. Thymoma (56.2%) and schwannoma (43.8%) represented the predominant histological diagnoses in the thymectomy and mass excision cohorts, respectively. Lesions involving the anterior, superior, and posterior mediastinum were all successfully resected. In this early series, SP robotic mediastinal mass resection was completed safely when access was tailored to tumor anatomy. Individualized access planning may extend the applicability of this platform beyond conventional anterior mediastinal procedures.