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.
- 1Department of Thoracic Surgery, Otsu Red Cross Hospital, Otsu, Japan.
Abstract
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. We conducted a retrospective comparative cohort study (June 2024-April 2026) of 26 consecutive patients undergoing lean DRATS and 43 patients undergoing conventional 4-5 port RATS for anatomical lung resection. The lean strategy was characterized by a minimalist 2-port setup, the elimination of CO2 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. Baseline characteristics, including the lobectomy/segmentectomy ratio (7/19 in DRATS vs. 18/25 in conventional, P=0.30), were comparable. For lean DRATS vs. conventional RATS: median operative time was 246 (range, 171-389) vs. 256 (151-436) minutes (P=0.56); median console time was 169 (114-259) vs. 180 (64-345) minutes (P=0.95); and median blood loss was 27 (2-434) vs. 25 (2-725) g (P=0.61). No conversions to thoracotomy occurred in either group. The major complication rate (grade ≥3) was 3.8% (1/26) vs. 2.3% (1/43) (P>0.99). Notably, the median hospital stay was significantly shorter in the lean DRATS group [5 (3-17) vs. 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. 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.
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BibTeX
@article{shoji2026lean,
title = {{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.}},
author = {Tsuyoshi Shoji and Shunji Cho and Takuzo Sakaguchi and Keisuke Hanawa and Mamoru Takahashi and Hiromichi Katakura},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1568},
url = {https://europepmc.org/article/MED/42996663},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Tsuyoshi Shoji
AU - Shunji Cho
AU - Takuzo Sakaguchi
AU - Keisuke Hanawa
AU - Mamoru Takahashi
AU - Hiromichi Katakura
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1568
UR - https://europepmc.org/article/MED/42996663
AB - 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. We conducted a retrospective comparative cohort study (June 2024-April 2026) of 26 consecutive patients undergoing lean DRATS and 43 patients undergoing conventional 4-5 port RATS for anatomical lung resection. The lean strategy was characterized by a minimalist 2-port setup, the elimination of CO2 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. Baseline characteristics, including the lobectomy/segmentectomy ratio (7/19 in DRATS vs. 18/25 in conventional, P=0.30), were comparable. For lean DRATS vs. conventional RATS: median operative time was 246 (range, 171-389) vs. 256 (151-436) minutes (P=0.56); median console time was 169 (114-259) vs. 180 (64-345) minutes (P=0.95); and median blood loss was 27 (2-434) vs. 25 (2-725) g (P=0.61). No conversions to thoracotomy occurred in either group. The major complication rate (grade ≥3) was 3.8% (1/26) vs. 2.3% (1/43) (P>0.99). Notably, the median hospital stay was significantly shorter in the lean DRATS group [5 (3-17) vs. 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. 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.
SN - 2072-1439
SN - 2077-6624
ER -