Surgical technique, details and tricks of full robot-assisted uniportal left upper lung lobectomy

Abstract: In the last two decades, thoracic surgery has undergone rapid development with the introduction of minimally invasive techniques. Since the first robot-assisted lung resection was performed by Melfi in Italy in 2002, robotic-assisted thoracoscopic surgery (RATS) has become established worldwide with a multiport approach. Over time, the RATS techniques have proven to be effective for both surgical and oncological major lung resections including anatomical segmental resections, complex sleeve resections and after neoadjuvant treatment. The most recent evolution of the RATS technique is the uniportal RATS (uRATS) technique, developed by Diego Gonzalez-Rivas in 2021. Since its introduction, uRATS has proven to be safe and adequate for oncologic lung resection (whether they are lobectomies, anatomical as well as complex resections) ensuring all the advantages of robotic surgery together with the least invasive surgical approach. However, these procedures have been published mainly by one group of surgeons, reducing the reproducibility and standardization of the technique. In this article we present the surgical technique for uRATS used in Thoracic Surgery Unit, Careggi University Hospital, explaining step by step the procedure details and technical aspects of a left upper lobectomy and presenting advantages and disadvantages encountered as well as tips and tricks derived from our experience.