Chinese clinical expert consensus on multi-arm robotic-assisted uniportal pulmonary resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAO Deping , HU Xuefei , YANG Chenlu , NING Ye , ZHU Yuming , JIANG Lei , HE Wenxin , CHEN Chang , Shanghai Medical Doctor Association, Thoracic Surgery Branch

Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, 200433, P. R. China;

Corresponding?author：

ZHAO Deping, Email: dpzhao@#edu.cn

Keywords：

Multi-arm robot; uniport; pulmonary resection; key technical points; learning curve; expert consensus

DOI：

10.7507/1007-4848.202605023

Video：

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Multi-arm robotic-assisted uniportal pulmonary resection is an emerging minimally invasive technique that enables anatomical pulmonary resection through a single incision using a multi-arm robotic platform. This consensus was initiated by Shanghai Pulmonary Hospital and developed through a multidisciplinary national expert panel. Using evidence-based methodology and expert survey, it provides a comprehensive overview of the clinical application of this technique, including its definition, indications and contraindications, technical considerations, and learning curve. As the first expert consensus focused on multi-arm robotic-assisted uniportal pulmonary resection, this consensus highlights the feasibility and developmental potential of the technique, which integrates existing robotic systems with uniportal minimally invasive principles. The consensus also offers theoretical and practical guidance for the standardized and safe implementation of the technique.

1.	Wu CF, Cheng C, Suen KH, et al. A preclinical feasibility study of single-port robotic subcostal anatomical lung resection and subxiphoid thymectomy using the da Vinci? SP system[J]. Diagnostics, 2023, 13(3): 460.
2.	陶紹霖, 陳大理, 康珀銘, 等. 單孔機器人輔助肺葉切除的動物實驗[J]. 重慶醫科大學學報, 2025, 50(2): 250-253.Tao SL, Chen DL, Kang PM, et al. Lobectomy with a single-port robotic surgical system: an animal experiment[J]. J Chongqing Med Univ, 2025, 50(2): 250-253.
3.	Yang Y, Song L, Huang J, et al. A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer[J]. Transl Lung Cancer Res, 2021, 10(3): 1571-1575.
4.	Gonzalez-Rivas D, Bosinceanu M, Manolache V, et al. Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases[J]. Ann Cardiothorac Surg, 2023, 12(1): 9-22.
5.	E H, Yang C, Wu J, et al. Hybrid uniportal robotic-assisted thoracoscopic surgery using video-assisted thoracoscopic surgery staplers: technical aspects and results[J]. Ann Cardiothorac Surg, 2023, 12(1): 34-40.
6.	Manolache V, Motas N, Bosinceanu ML, et al. Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience[J]. Ann Cardiothorac Surg, 2023, 12(2): 102-109.
7.	Paradela M, Garcia-Perez A, Fernandez-Prado R, et al. Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases[J]. Ann Cardiothorac Surg, 2023, 12(1): 23-33.
8.	Stamenovic D, Schiller P, Karampinis I, et al. Uniportal robotic assisted surgery for anatomical lung resection-first German experience[J]. Int J Med Robot, 2023, 4: e2580.
9.	Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results[J]. J Thorac Cardiovasc Surg, 2006, 131(1): 54-59.
10.	Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J]. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
11.	Veronesi G. Robotic thoracic surgery: technical considerations and learning curve for pulmonary resection[J]. Thorac Surg Clin, 2014, 24(2): 135-141.
12.	Melfi FM, Fanucchi O, Davini F, et al. VATS-based approach for robotic lobectomy[J]. Thorac Surg Clin, 2014, 24(2): 143-149.
13.	Nasir BS, Bryant AS, Minnich DJ, et al. Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes[J]. Ann Thorac Surg, 2014, 98(1): 203-208.
14.	Alturki A, Alturki F, Koziej P, et al. Perioperative outcomes of uniportal robotic-assisted thoracic surgery (U-RATS) for lung resection: state of the art-a narrative review[J]. Curr Chall Thorac Surg, 2024, 6: 33.
15.	Miyajima M, Maki R, Arai W, et al. Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer[J]. J Thorac Dis, 2022, 14(6): 1890-1899.
16.	Li Q, Li Y, Lin L, et al. Evolution of minimally invasive thoracic surgery[J]. Ann Cardiothorac Surg, 2023, 12(2): 128-129.
17.	Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases[J]. Ann Thorac Surg, 2012, 93(5): 1598-1604.
18.	Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
19.	Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS)[J]. Transl Lung Cancer Res, 2020, 9(4): 971-987.
20.	Ning Y, Chen Z, Zhang W, et al. Short-term outcomes of uniportal robotic-assisted thoracic surgery anatomic pulmonary resections: experience of Shanghai Pulmonary Hospital[J]. Ann Cardiothorac Surg, 2023, 12(2): 117-125.
21.	Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database[J]. Ann Thorac Surg, 2014, 97(1): 236-242.
22.	Kneuertz PJ, Singer E, D'Souza DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison[J]. J Thorac Cardiovasc Surg, 2019, 157(5): 2018-2026. e2.
23.	Deen SA, Wilson JL, Wilshire CL, et al. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches[J]. Ann Thorac Surg, 2014, 97(3): 1000-1007.
24.	Park BJ. Cost concerns for robotic thoracic surgery[J]. Ann Cardiothorac Surg, 2012, 1(1): 56-58.
25.	Gonzalez-Rivas D, Manolache V, Bosinceanu ML, et al. Uniportal pure robotic-assisted thoracic surgery-technical aspects, tips and tricks[J]. Ann Transl Med, 2023, 11(10): 362.
26.	Amore D, Di Natale D, Scaramuzzi R, et al. Reasons for conversion during VATS lobectomy: what happens with increased experience[J]. J Vis Surg, 2018, 4: 53.
27.	Sawada S, Komori E, Yamashita M. Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy[J]. Eur J Cardiothorac Surg, 2009, 36(3): 487-490.
28.	Power AD, Merritt RE, Abdel-Rasoul M, et al. Estimating the risk of conversion from video-assisted thoracoscopic lung surgery to thoracotomy: a systematic review and meta-analysis[J]. J Thorac Dis, 2021, 13(2): 812-823.
29.	Gómez-Hernández MT, Fuentes MG, Novoa NM, et al. The robotic surgery learning curve of a surgeon experienced in video-assisted thoracoscopic surgery compared with his own video-assisted thoracoscopic surgery learning curve for anatomical lung resections[J]. Eur J Cardiothorac Surg, 2022, 61(2): 289-296.
30.	Mercadante E, Martucci N, De Luca G, et al. Early experience with uniportal robotic thoracic surgery lobectomy[J]. Front Surg, 2022, 9: 1005860.

1. Wu CF, Cheng C, Suen KH, et al. A preclinical feasibility study of single-port robotic subcostal anatomical lung resection and subxiphoid thymectomy using the da Vinci? SP system[J]. Diagnostics, 2023, 13(3): 460.
2. 陶紹霖, 陳大理, 康珀銘, 等. 單孔機器人輔助肺葉切除的動物實驗[J]. 重慶醫科大學學報, 2025, 50(2): 250-253.Tao SL, Chen DL, Kang PM, et al. Lobectomy with a single-port robotic surgical system: an animal experiment[J]. J Chongqing Med Univ, 2025, 50(2): 250-253.
3. Yang Y, Song L, Huang J, et al. A uniportal right upper lobectomy by three-arm robotic-assisted thoracoscopic surgery using the da Vinci (Xi) Surgical System in the treatment of early-stage lung cancer[J]. Transl Lung Cancer Res, 2021, 10(3): 1571-1575.
4. Gonzalez-Rivas D, Bosinceanu M, Manolache V, et al. Uniportal fully robotic-assisted sleeve resections: surgical technique and initial experience of 30 cases[J]. Ann Cardiothorac Surg, 2023, 12(1): 9-22.
5. E H, Yang C, Wu J, et al. Hybrid uniportal robotic-assisted thoracoscopic surgery using video-assisted thoracoscopic surgery staplers: technical aspects and results[J]. Ann Cardiothorac Surg, 2023, 12(1): 34-40.
6. Manolache V, Motas N, Bosinceanu ML, et al. Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience[J]. Ann Cardiothorac Surg, 2023, 12(2): 102-109.
7. Paradela M, Garcia-Perez A, Fernandez-Prado R, et al. Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases[J]. Ann Cardiothorac Surg, 2023, 12(1): 23-33.
8. Stamenovic D, Schiller P, Karampinis I, et al. Uniportal robotic assisted surgery for anatomical lung resection-first German experience[J]. Int J Med Robot, 2023, 4: e2580.
9. Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results[J]. J Thorac Cardiovasc Surg, 2006, 131(1): 54-59.
10. Veronesi G, Galetta D, Maisonneuve P, et al. Four-arm robotic lobectomy for the treatment of early-stage lung cancer[J]. J Thorac Cardiovasc Surg, 2010, 140(1): 19-25.
11. Veronesi G. Robotic thoracic surgery: technical considerations and learning curve for pulmonary resection[J]. Thorac Surg Clin, 2014, 24(2): 135-141.
12. Melfi FM, Fanucchi O, Davini F, et al. VATS-based approach for robotic lobectomy[J]. Thorac Surg Clin, 2014, 24(2): 143-149.
13. Nasir BS, Bryant AS, Minnich DJ, et al. Performing robotic lobectomy and segmentectomy: cost, profitability, and outcomes[J]. Ann Thorac Surg, 2014, 98(1): 203-208.
14. Alturki A, Alturki F, Koziej P, et al. Perioperative outcomes of uniportal robotic-assisted thoracic surgery (U-RATS) for lung resection: state of the art-a narrative review[J]. Curr Chall Thorac Surg, 2024, 6: 33.
15. Miyajima M, Maki R, Arai W, et al. Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer[J]. J Thorac Dis, 2022, 14(6): 1890-1899.
16. Li Q, Li Y, Lin L, et al. Evolution of minimally invasive thoracic surgery[J]. Ann Cardiothorac Surg, 2023, 12(2): 128-129.
17. Louie BE, Farivar AS, Aye RW, et al. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases[J]. Ann Thorac Surg, 2012, 93(5): 1598-1604.
18. Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
19. Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS)[J]. Transl Lung Cancer Res, 2020, 9(4): 971-987.
20. Ning Y, Chen Z, Zhang W, et al. Short-term outcomes of uniportal robotic-assisted thoracic surgery anatomic pulmonary resections: experience of Shanghai Pulmonary Hospital[J]. Ann Cardiothorac Surg, 2023, 12(2): 117-125.
21. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database[J]. Ann Thorac Surg, 2014, 97(1): 236-242.
22. Kneuertz PJ, Singer E, D'Souza DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison[J]. J Thorac Cardiovasc Surg, 2019, 157(5): 2018-2026. e2.
23. Deen SA, Wilson JL, Wilshire CL, et al. Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches[J]. Ann Thorac Surg, 2014, 97(3): 1000-1007.
24. Park BJ. Cost concerns for robotic thoracic surgery[J]. Ann Cardiothorac Surg, 2012, 1(1): 56-58.
25. Gonzalez-Rivas D, Manolache V, Bosinceanu ML, et al. Uniportal pure robotic-assisted thoracic surgery-technical aspects, tips and tricks[J]. Ann Transl Med, 2023, 11(10): 362.
26. Amore D, Di Natale D, Scaramuzzi R, et al. Reasons for conversion during VATS lobectomy: what happens with increased experience[J]. J Vis Surg, 2018, 4: 53.
27. Sawada S, Komori E, Yamashita M. Evaluation of video-assisted thoracoscopic surgery lobectomy requiring emergency conversion to thoracotomy[J]. Eur J Cardiothorac Surg, 2009, 36(3): 487-490.
28. Power AD, Merritt RE, Abdel-Rasoul M, et al. Estimating the risk of conversion from video-assisted thoracoscopic lung surgery to thoracotomy: a systematic review and meta-analysis[J]. J Thorac Dis, 2021, 13(2): 812-823.
29. Gómez-Hernández MT, Fuentes MG, Novoa NM, et al. The robotic surgery learning curve of a surgeon experienced in video-assisted thoracoscopic surgery compared with his own video-assisted thoracoscopic surgery learning curve for anatomical lung resections[J]. Eur J Cardiothorac Surg, 2022, 61(2): 289-296.
30. Mercadante E, Martucci N, De Luca G, et al. Early experience with uniportal robotic thoracic surgery lobectomy[J]. Front Surg, 2022, 9: 1005860.

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