Robotic lobectomy with a single robotic stapler from one 12-mm port: a multi-institutional study

Abstract

Abstract Objectives: The introduction of the robotic stapler has made it possible to perform a robotic lobectomy from the console in complete autonomy. The robotic stapler fits a 12-mm port, which is larger than the standard 8-mm port and increases the risk of postoperative neuralgia. However, in many cases, to cover all possible angles of approach, two 12-mm ports are preferably placed. Meanwhile, limiting instruments and simplifying surgical procedures are also required to reduce costs. Methods: We assessed the feasibility of robotic lobectomy with a single type of robotic stapler inserted through one 12-mm port placed at the anterior tip of the lower intercostal space, and applied a SureForm45 Curved-Tip (Intuitive Surgical Inc., Sunnyvale, CA, USA) in a multicenter setting. We also investigated the potential cost-saving of using an additional 60-mm stapler for interlobar division. Results: A total of 135 lobectomy cases were enrolled. In all the cases, all stapling procedures were completed using a SureForm45 Curved-Tip inserted from the designated 12-mm port. We found that it was less expensive to use the SureForm60 if more than six SureForm45 Curved-Tips were needed for interlobar division. Nevertheless, in our series, only one case (0.7%) met this requirement. Conclusion: The use of a single type of stapler from one 12-mm port in a robotic lobectomy is a technically feasible approach, which expected to allow for surgical simplification, minimize the risk of neuralgia, and reduce inventory costs.