Safe implementation of robot-assisted thoracic surgery in the UK: a single-centre experience and early outcomes

Background: Robot-assisted thoracic surgery (RATS) is a recognised alternative to video-assisted thoracic surgery (VATS) but remains under utilised in the UK. We describe the establishment of a RATS lobectomy service, outlining peri-operative outcomes and learning curve trends. Methods: We retrospectively analysed peri-operative variables, post-operative complications, and learning curve progression in patients undergoing RATS lobectomy. Outcomes assessed included operation time, length of stay, complication rates, and composite technical failure (conversion, reoperation, or peri-operative death). Learning curve analysis was performed using grouped sequential cases and cumulative sum (CUSUM) methodology. Results: Between June 2022 and December 2024, 140 patients [60M:80F, median age 71 (range 42–86)] underwent RATS lobectomy by one surgeon. Median FEV1, FVC, and DLCO were 95.6%, 106%, and 81.3%, respectively. Eighty-nine cases (63.6%) were right-sided, with a median operative time of 125.5 minutes. Four patients (2.9%) required conversion (three due to adhesions, one due to bleeding). Median air leak duration was 2 days, and median hospital stay 4 days. Thirty-three patients (23.6%) developed complications: chest infection (9.3%), respiratory failure (1.4%), sepsis (1.4%) and cerebrovascular accident (0.7%). Three patients (2.1%) required re-exploration. There were two 30-day and one 90-day mortalities, but no intraoperative mortalities. Learning curve analysis demonstrated significant improvement in operative time (p < 0.001), with proficiency achieved after 59 cases. Composite technical proficiency was achieved after 79 cases. Conclusions: RATS lobectomy was safely established with low conversion and acceptable morbidity. Structured preparation, proctor involvement, and multidisciplinary engagement facilitated safe adoption, while efficiency improved without compromising safety.