Single-port robotic segmentectomy using the da Vinci SP system for non-small cell lung cancer

초록

Objectives: Robot-assisted thoracic surgery using the single-port robotic system is a novel minimally invasive approach; however, clinical data on its use for anatomical segmentectomy remain limited. Therefore, this single-center retrospective cohort study aimed to investigate the safety and feasibility of this technique for segmentectomy by comparing its perioperative outcomes with those of multi-port robot-assisted thoracic surgery and video-assisted thoracoscopic surgery. Methods: Data from patients with non-small cell lung cancer who underwent anatomical segmentectomy from April 2014 to April 2025 were analyzed. Patients were categorized into single-port and multi-port robot-assisted thoracic surgery groups and video-assisted thoracoscopic surgery group according to the surgical approach. Perioperative outcomes were analyzed after propensity score matching. Results: A total of 345 patients were included in the analysis: single-port robot-assisted thoracic surgery (SP-RATS, n = 50), multi-port robot-assisted thoracic surgery (MP-RATS, n = 75), and video-assisted thoracoscopic surgery (VATS, n = 220). Following matching, 47 patients were included in each group. All patients in the single-port robot-assisted thoracic surgery group underwent complete resection (R0) without conversion to open thoracotomy. In the matched cohort, the SP-RATS group demonstrated a significantly shorter total operative time than that of the MP-RATS group (p < 0.001), whereas no significant difference was observed between the SP-RATS and the VATS groups. In addition, the SP-RATS group had a significantly shorter duration of chest tube drainage than those of the MP-RATS and VATS groups (p = 0.015 and p = 0.039, respectively). No significant differences were observed between groups in terms of postoperative complications, postoperative pain, or pathological outcomes, including the number of harvested lymph nodes. Conclusions: Robotic segmentectomy using the da Vinci SP system appears safe and feasible, with favorable short-term perioperative outcomes. Large-scale, well-designed prospective trials with long-term follow-up are remained warranted to validate its clinical efficacy.

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