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

Safe implementation of robot-assisted thoracic surgery in the UK: a single-centre experience and early outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safe implementation of robot-assisted thoracic surgery in the UK: a single-centre experience and early outcomes Michelle Lee, Ee Phui Kew, Mark Edsell, Jeremy Smelt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8262554/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 13 You are reading this latest preprint version Abstract 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. Robot-assisted thoracic surgery thoracic surgery lobectomy Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 05 Apr, 2026 Reviews received at journal 25 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviews received at journal 04 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 18 Dec, 2025 Submission checks completed at journal 18 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8262554","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585802235,"identity":"7d3cba61-9206-4fa4-a02b-89fcaa4473ba","order_by":0,"name":"Michelle Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYFAC5gYGxn82DAYkaGFsYGBgS4NqSSBey2EStOg2MDY++MBzPs+c/wDbg48/iNBidoCx2XCGxO1iyxkJ7IYziLEFqKVNmsfgduKGGwxs0jxEamn//SfhXOKG8wfYpP8Qawszw4EDiRsOJLBJE+V9s8OMzZK9DclAhyW2SfakEaPlePPBDz8b7IAOO3xM4ocNEVoYmOEsUASNglEwCkbBKKAOAACAXDgGxR3tZwAAAABJRU5ErkJggg==","orcid":"","institution":"St George’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Michelle","middleName":"","lastName":"Lee","suffix":""},{"id":585802236,"identity":"b798eaa0-235d-4c25-aa00-76737885d493","order_by":1,"name":"Ee Phui Kew","email":"","orcid":"","institution":"Royal Brompton Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ee","middleName":"Phui","lastName":"Kew","suffix":""},{"id":585802237,"identity":"f2b9090c-20e4-496b-adb5-ae0c40970142","order_by":2,"name":"Mark Edsell","email":"","orcid":"","institution":"Royal Brompton Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"","lastName":"Edsell","suffix":""},{"id":585802238,"identity":"6450eaac-595e-41e5-9068-3fe85084a4ce","order_by":3,"name":"Jeremy Smelt","email":"","orcid":"","institution":"St George’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"","lastName":"Smelt","suffix":""}],"badges":[],"createdAt":"2025-12-02 16:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8262554/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8262554/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-026-04147-0","type":"published","date":"2026-04-24T15:59:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107928745,"identity":"46c644af-f77a-4e46-aa50-27a9fd200f64","added_by":"auto","created_at":"2026-04-27 16:12:21","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":807618,"visible":true,"origin":"","legend":"","description":"","filename":"MichelleRATSImplementation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8262554/v1_covered_bb871c31-ce53-4088-8395-9e04e750c222.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safe implementation of robot-assisted thoracic surgery in the UK: a single-centre experience and early outcomes","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Robot-assisted thoracic surgery, thoracic surgery, lobectomy","lastPublishedDoi":"10.21203/rs.3.rs-8262554/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8262554/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eRobot-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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eBetween 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 \u0026lt; 0.001), with proficiency achieved after 59 cases. Composite technical proficiency was achieved after 79 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eRATS 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.\u003c/p\u003e","manuscriptTitle":"Safe implementation of robot-assisted thoracic surgery in the UK: a single-centre experience and early outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 17:03:51","doi":"10.21203/rs.3.rs-8262554/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-05T09:59:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T15:16:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T02:01:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186127618063611453978501377589604021684","date":"2026-02-09T08:06:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T08:14:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T15:08:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267941643827079168042814791782291366924","date":"2026-02-04T13:05:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214913925443282377706624386626819141454","date":"2026-02-04T03:19:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68791514988213379085160057021652658141","date":"2026-02-03T14:44:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T11:51:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T06:43:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T06:39:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-12-02T16:02:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b53517f-8c13-45a0-9ef8-5a9eeb3ed761","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:09:56+00:00","versionOfRecord":{"articleIdentity":"rs-8262554","link":"https://doi.org/10.1186/s13019-026-04147-0","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2026-04-24 15:59:00","publishedOnDateReadable":"April 24th, 2026"},"versionCreatedAt":"2026-02-05 17:03:51","video":"","vorDoi":"10.1186/s13019-026-04147-0","vorDoiUrl":"https://doi.org/10.1186/s13019-026-04147-0","workflowStages":[]},"version":"v1","identity":"rs-8262554","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8262554","identity":"rs-8262554","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}