Lean dual-portal versus conventional multi-portal robotic-assisted thoracic surgery for anatomical lung resection: a retrospective comparative cohort study of a sustainable approach harmonizing clinical efficiency, environmental protection, and next-generation education
Year: 2026
Type: article
Abstract: Background: Conventional robotic-assisted thoracic surgery (RATS) is increasingly scrutinized for its high procedural costs, excessive medical plastic waste, and the passive role it often assigns to surgical trainees. To address these systemic inefficiencies, we introduced the 'lean' dual-portal RATS (DRATS) strategy. This study evaluates the clinical feasibility and multi-dimensional benefits of this approach, which prioritizes resource stewardship and educational autonomy. Methods: insufflation and specialized cannula seals, and the proactive 'Bedside Surgeon' model. Allocation to the DRATS group was determined by the daily availability of a designated fixed surgical team, minimizing selection bias. Primary outcomes included operative efficiency and safety, with complications recorded via the Clavien-Dindo classification. Patients were followed through outpatient clinic visits to monitor for late complications and confirm the absence of readmissions. Results: 6 (4-66) days, P<0.001]. No patients in either group required readmission after discharge. The "lean" strategy achieved a cost reduction of approximately 118,000 JPY ($762 USD) per case by eliminating specialized seals and utilizing resident-operated manual endoscopic stapling executed synchronously during active console time. Conclusions: This small, single-center study suggests that the 'lean' DRATS approach is feasible for anatomical lung resection in a selected group of patients. While the strategy significantly reduced procedural costs and shortened hospital stay without compromising immediate safety, its equivalence to conventional robotic surgery requires further validation through larger prospective trials.
Source: Journal of Thoracic Disease
Institution: Otsu Red Cross Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224024429