[Quantitative Evaluation of Assistant Intervention in Robotic-assisted Lung Resection and Feasibility of Solo-surgery].

Abstract

With the increasing adoption of robot-assisted thoracic surgery( RATS), the role of surgical assistants has evolved compared to traditional open or video-assisted thoracic surgery( VATS). At our institution, a 5-port look-up view approach with the da Vinci Xi system has been in use since May 2021, and since June 2024, we have transitioned to a solo-surgery approach in which the primary surgeon independently manages both console operation and surgical field exposure. In this retrospective single-center study, we quantitatively evaluated assistant interventions in 115 cases during the introduction phase and 45 cases during the solo-surgery phase. Assistant interventions such as suctioning and retraction significantly decreased in the solo-surgery phase, while port hopping-a technique allowing instrument switching by the surgeon-was introduced as an alternative. No conversions to thoracotomy or blood transfusions occurred throughout the study period. These findings suggest that, with appropriate strategies and technical adaptations, solo-surgery in RATS is not only feasible but can be performed safely without compromising operative outcomes.