Initial surgical results of subcostal uniportal robotic lung resection: a study of the perioperative outcomes and a CUSUM analysis of the learning curve.

PURPOSE: Anatomical lung resection using the da Vinci SP system was recently introduced in Japan. We retrospectively evaluated our initial experience and analyzed the learning curve for the first 53 consecutive cases. METHODS: Fifty-three patients with primary lung cancer underwent anatomical resection, including lobectomy and segmentectomy, using the da Vinci SP system. We reviewed the perioperative outcomes, including the operative time, console time, conversion rates, and complications. The learning curves for operative and console times were assessed using a cumulative summation analysis. RESULTS: The mean patient age was 71.5 years. Thirty-five and 18 patients underwent lobectomy and segmentectomy, respectively. The mean operative and console times were 207.1 min and 147.5 min, respectively. Two patients (4%) required conversion to an open thoracotomy. Two patients (4%) experienced Clavien-Dindo grade ≥ II postoperative complications, with no severe morbidity. A cumulative summation analysis indicated that the learning curve for lobectomy plateaued after the 14th case, whereas proficiency for all resections was achieved after 18-19 cases. CONCLUSION: Anatomical lung resection using the da Vinci SP system can be safely performed with favorable short-term outcomes. Surgeons with experience in multiport robotics may achieve proficiency in approximately 14-18 cases.