Single-Port Robotic-Assisted Thoracic Surgery Using da Vinci Single-Port System

摘要

Background: Neoadjuvant immunotherapy is an emerging approach for patients with non-small cell lung cancer (NS-CLC), showing promise in reducing recurrence rates and improving survival outcomes.Recent clinical trials have demonstrated encouraging pathological response rates and the feasibility of surgery following immunotherapy.However, the safety and feasibility of robotic-assisted thoracic surgery (RATS) after neoadjuvant immunotherapy remain controversial.In the present study, we aimed to evaluate the feasibility of RATS in NSCLC patients after neoadjuvant immunotherapy.Methods: This retrospective study reviewed patients with NSCLC who underwent RATS following neoadjuvant immunotherapy between January 2022 and December 2024 at a single center.The primary outcomes included total operative time, conversion to open thoracotomy, and postoperative complications.Results: A total of 14 patients were included in the study, of whom 6 underwent single-port robotic surgery using the da Vinci single-port robotic system, while the remaining 8 underwent multi-port surgery using the da Vinci Xi system.All patients were male, with a median age of 66 years (interquartile range [IQR], 61-68 years).The R0 resection rate was 100%.The median operative time was 262 minutes (IQR, 162-302 minutes).Conversion to thoracotomy was required in 1 case, while conversion to VATS was performed in 2 cases.The median postoperative hospital stay was 6 days (IQR, 3-8 days), and the median duration of chest tube placement was 4 days (IQR, 2-6 days).Major postoperative complications, defined as Clavien-Dindo grade IIIb, occurred in only 1 patient.Conclusion: Our study suggests that RATS following neoadjuvant immunotherapy is both safe and feasible for patients with NSCLC.While further large-scale studies are needed to refine patient selection criteria and validate long-term efficacy, continuous advancements in robotic technology and surgical techniques may further establish RATS as a promising treatment strategy.