Subxiphoid or subcostal uniportal robotic-assisted surgery: early experimental experience

During the past several years minimally invasive thoracic surgery has evolved from thoracoscopic approaches using 3–4 ports to a single incision video-assisted thoracoscopic surgery (VATS) techniques (1-3). Recently, the experience acquired with the uniportal VATS technique through the intercostal space has allowed the development of use of a uniportal VATS subxiphoid or subcostal approach for major pulmonary resections (4,5). The advantage of using a subxiphoid or subcostal entry is to reduce pain by avoiding possible trauma of intercostal nerves caused by thoracic incisions. However, the longer distance from the subxiphoid or subcostal incision to the hilum makes this approach more difficult to perform major pulmonary resections. Nevertheless, in expert hands this technique allows the possibility to perform complex resections (6), lymph node dissection (7) and anatomic segmentectomies (8)