Robotic-Assisted Single-Port Subcostal Entry Technique: The Cornell Method

The single-port (SP) robotic platform (da Vinci SP, Intuitive Surgical) was recently cleared by the United States Food and Drug Administration for use in thoracic surgery.1 Emerging experience supports the safety and feasibility of the SP system for selected pulmonary and mediastinal procedures.2–4 Our institution has established a high-volume program for SP thoracic surgery through a deliberate multi-surgeon adoption model. Single-port lung resection using subxiphoid or subcostal access has previously been described in both robotic and video-assisted thoracoscopic surgery.4,5 These extrathoracic approaches avoid intercostal access and have the potential to reduce postoperative pain by minimizing intercostal nerve injury. While the subxiphoid approach is well described, the subcostal approach for pulmonary resection remains non-standard, with limited representation in the thoracic surgical literature. Safe access to the subdiaphragmatic region without violating the peritoneal cavity is technically challenging because of the diaphragm’s concavity, depth, and laxity, particularly in the setting of single-port instrumentation.