A modified Cerfolio technique for robotic pulmonary resection: a retrospective comparison with the conventional approach.

Abstract

Objective(s): The Cerfolio-based technique is widely used for robotic pulmonary resection; however, multiple intercostal ports, particularly a posterior dorsal port, may increase invasiveness. We developed a modified Cerfolio technique (ModC) that integrates the retraction arm into the utility incision to reduce posterior intercostal ports while preserving independent four-arm manipulation.

Methods: We retrospectively reviewed 72 consecutive robotic pulmonary resections at a single institution (April 2024-November 2025): conventional Cerfolio-based approach (C group, n = 41) or ModC (n = 31; introduced April 2025). Both approaches used four robotic arms, a 30° down scope, and no CO₂ insufflation. Console time, operative time, estimated blood loss, and perioperative complications were compared.

Results: The distribution of lobectomy and segmentectomy was similar between groups (p = 0.635). Median console time was 134 min in the C group and 121 min in the ModC group (p = 0.096). Median operative time was 175 versus 156 min (p = 0.051), and median blood loss was 5 versus 3 mL (p = 0.172). Major complications (Clavien-Dindo grade ≥ III) occurred in 3 patients (7.3%) in the C group and 1 (3.2%) in the ModC group (p = 0.629). No reoperation, readmission within 30 days, or 30-day mortality occurred.

Conclusions: ModC, a minimal modification of a Cerfolio-based workflow, can be introduced smoothly without compromising short-term outcomes.