Background: Robotic-assisted thoracic surgery has been widely used in the treatment of lung cancer. We devised a new port arrangement at robot-assisted thoracoscopic surgery for lung cancer, the “Hamamatsu method” to provide a good cranial field of view using the da Vinci Xi surgical system, last year. It consists of four robot ports and one assist port, while our video-assisted thoracoscopic lobectomy is performed with four ports.
Methods: By combining the access port and camera port of “Hamamatsu Method”, we devised the 4-port “Hamamatsu Method KAI” equivalent to the conventional 5-port method without changing the operability. Then, in order to prove the safety of “Hamamatsu Method KAI,” the bleeding volume, drain placement period, operation time, and console time were compared with the conventional 5-port case.
Results: In 18 cases of lung cancer who underwent anatomical lung resection by “Hamamatsu Method KAI,” there was no significant difference in bleeding volume, drain placement period, operation time, and console time compared with the conventional 5-port case. No thoracotomy conversion case was detected.
Conclusions: Robotic surgery should not ideally increase the number of wounds than thoracoscopic surgery to preserve the minimal invasiveness advantage. Furthermore, patients are generally more sensitive to wound size and number than what surgeons assume. Therefore, we devised a method to reduce the number of ports without degrading the robotic surgery quality. The improved 4-port “Hamamatsu Method KAI” method combines the access port with the camera port and helps ensure minimal invasiveness while maintaining the same feasibility as the original method.