WCLC 2025 - Posters & ePosters-EP.07.35 Comparative Analysis of Anterior and Posterior Approaches in Robotic Pulmonary Resection

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This study from Oita University, Japan, compares anterior and posterior surgical approaches in robotic pulmonary resection (RPR) using da Vinci systems. The retrospective analysis includes 85 consecutive patients treated between 2020 and 2025, assessing outcomes, learning curves, and procedural details. The anterior approach, performed with the da Vinci Si system (2020–2023), features ports on the axillary incision and offers easy access to the hilum and pulmonary vessels, resembling uniport/multiport VATS views but with limited visualization even with CO2 insufflation. The posterior approach, used with the da Vinci Xi system (2023–2024), places ports on posterolateral incisions, resembling an open/hybrid thoracotomy view and facilitating lymph node dissection and interlobar resection without CO2 insufflation, but limits endotracheal tube access.<br /><br />Results showed no significant differences in operation time (median ~250 minutes), console time (~177 minutes), blood loss (median zero), postoperative complications (18-20%), drainage duration, or hospital stay between approaches. However, stapler usage was significantly higher in the posterior approach (median 7 units vs. 5 in anterior, p=0.0008), likely reflecting more segmentectomies performed posteriorly (20% vs. 2.6%, p=0.009). Complications correlated with longer operation times and increased drainage duration but not with the approach type.<br /><br />Learning curve analysis via cumulative sum (CUSUM) charts indicated that proficiency was rapidly achieved after about 3–4 cases for surgeons with varying experience. The posterior approach provided greater visibility and workspace for stapling, thus supporting safer and more effective training. The study concludes that while both approaches are safe and feasible, the posterior approach with the da Vinci Xi system may facilitate better surgeon training and complex resections due to improved visualization and working space, despite slightly increased stapler use. The anterior approach remains useful but with some limitations in stapling and view.<br /><br />Overall, this comparative analysis supports adopting the posterior approach for robotic pulmonary resections to enhance surgical training and safety.

Asset Subtitle

Atsushi Osoegawa

Meta Tag

Speaker Atsushi Osoegawa

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

Robotic pulmonary resection

da Vinci surgical system

anterior approach

posterior approach

Oita University study

thoracic surgery

learning curve

segmentectomy

surgical outcomes

minimally invasive surgery