Impact on Respiratory Mechanics of Uniportal–Biportal Robotic Lung Resection Without Capnothorax Versus Multiportal Approach With Capnothorax: A Prospective Cohort Observational Study
Abstract
Background Several robotic‐assisted thoracic surgery (RATS) techniques have been described. Main differences among them are the location of ports and CO2 insufflation, with a potential impact on respiratory mechanics. This study assesses the respiratory impact of uniportal or biportal RATS (uRATS) without capnothorax versus a historical cohort of patients who had multiportal RATS (mRATS) with capnothorax. Methods Prospective, observational, and descriptive study enrolling adult patients (> 18 years/o) undergoing elective uRATS lung resection and comparison to an historical cohort of 30 mRATS patients, from July 2023 to February 2024. Protocolized recruitment maneuvers (RMs) were performed, and optimal positive end–expiratory pressure (PEEP) to best compliance was calculated during one‐lung ventilation (OLV). Respiratory parameters were collected intraoperatively: during two‐lung ventilation (TLV, T1), OLV before the RM (T2), OLV after the RM (T3), 20 min after the RM (T4), at the end of OLV (T5), and before extubation (T6). To test quantitative variables, a linear mixed‐effects model was used. Results A total of 30 patients undergoing uRATS were enrolled and compared to 30 patients undergoing mRATS in a previous study. At T3, patients in the uRATS group needed significantly lower PEEP (mean difference 5.3 cmH2O; p < 0.001), which was also translated to a lower P plat (4.2 cmH2O; p < 0.001) and P peak (4 cmH2O; p = 0.003). These differences were maintained at T4 and T5 but not at T6. Patients in the uRATS groups showed lower mechanical power at T4 and T5 (mean difference at T4 4.8 J/min, p < 0.001, and at T5 5.0 J/min, p < 0.001). Conclusions Uniportal and biportal robotic lung resection without capnothorax is associated with a lower impact on respiratory mechanics when compared to the multiportal robotic approach with capnothorax. Trial Registration: ClinicalTrials.gov identifier: NCT06784037