@article{oai:ir.kagoshima-u.ac.jp:00016659,
 author = {Ueda, Kazuhiro and Umehara, Tadashi and Maeda, Koki and Suzuki, Soichi and Yokomakura, Naoya and Kariatsumari, Kota and Sato, Masami},
 issue = {11},
 journal = {Translational Cancer Research},
 month = {Nov},
 note = {Background: Regardless of the current trend in reduced port surgery, robotic surgery generally requires multiple (≥4) skin incisions for robotic arms and patient-side surgeons. In addition, the use of multiple arms results in interreference between the arms and the patient-side surgeon. In the current study, we reviewed our initial experience of a less invasive robotic approach for lung cancer.
Methods: We used 3 arms of the Da Vinci Xi system in an original manner: the camera was set at the most ventral arm for patients and the forceps for right and left hands were set at the more dorsal arms. We made a 4-cm incision in the eighth intercostal space along the middle-axillary line for the insertion of 2 ports for a camera and forceps. This window was eventually used for the extraction of the resected lobes. In addition, we made 1-cm incision along the posterior-axillary line for the remaining arm, and a 1.5-cm incision along the anterior-axillary line for a utility window for the patient-side surgeon.
Results: Our port setting contributed to preventing interference between the 2 adjacent arms (camera and forceps), as well as to improving the performance of the patient-side surgeon who does not experience interference from the robotic arms. During the initial experiences of 39 patients, the same procedure was successfully completed by 3 different console surgeons. There were no catastrophic events during the operations or in the 90-day postoperative period, although we experienced 2 open conversions (5%) for noncritical bleeding.
Conclusions: We established a 3-incision robotic surgery for lung cancer, which in addition to being patient-friendly, may facilitates collaboration between the console-surgeon and patient-side surgeon without compromising the performance of the console surgeon.

Kazuhiro Ueda, Tadashi Umehara, Koki Maeda, Soichi Suzuki, Naoya Yokomakura, Kota Kariatsumari, Masami Sato
Three-incision robotic major lung resection for cancer
Translational Cancer Research 2021;10(11):4617-4623
https://dx.doi.org/10.21037/tcr-21-1772},
 pages = {4617--4623},
 title = {Three-incision robotic major lung resection for cancer},
 volume = {10},
 year = {2021}
}