Findings from the world’s first clinical trial (NCT06286150) of anatomical robotic lobectomy and segmentectomy for lung cancer using the Shurui® SR-ENS-600 single-port robotic surgical system were formally published in The Annals of Thoracic Surgery, a top-tier international journal in cardiothoracic surgery, in 2025. Led by the research team headed by Professor He Jianxing at the First Affiliated Hospital of Guangzhou Medical University, this study is the first to clinically verify the safety and feasibility of performing radical lung cancer resection via an transcostal approach with a domestically developed single-port robotic platform. Leveraging proprietary snake-arm technology and a specially engineered triple-channel trocar designed for thoracic surgery, the research addresses a core technical bottleneck plaguing existing single-port robotic systems such as the Da Vinci SP, which are constrained by inherent mechanical limits to subxiphoid or subcostal surgical access.

The Annals of Thoracic Surgery ranks among the world’s most authoritative and influential publications in cardiothoracic surgery with stringent peer-review and acceptance criteria. As the world’s first human clinical trial documenting radical lung cancer resection through an transcostal incision using a single-port robotic system, the study’s publication marks international peer recognition of China’s homegrown single-port robotic innovations in minimally invasive thoracic surgery. The original manuscript explicitly notes: “To date, no published clinical reports have described radical lung cancer resection via a lateral transcostal approach using a single-port robotic surgical platform.”

Designed as a single-center, prospective single-arm registered clinical trial, the research enrolled 35 lung cancer patients with a median age of 58 years, comprehensively evaluating the technical feasibility, surgical safety and short-term postoperative outcomes of the Shurui SR-ENS-600 system across 23 lobectomies and 12 segmentectomies. All procedures were completed via a single 3–4 cm incision at the 6th to 7th transcostal space along the anterior axillary line.

Core Clinical Outcomes

All 35 operations were completed successfully with a 100% procedural success rate; no conversions to open thoracotomy or conventional video-assisted thoracoscopic surgery (VATS) were needed, nor were additional trocar punctures required. As documented in the original paper: “All 35 anatomical lobectomy and segmentectomy procedures performed with the SHURUI SP single-port robotic system were completed without docking or intraprocedural positional issues. No cases required conversion to VATS or open surgery, or placement of supplementary trocars.” R0 resection plus systematic mediastinal lymph node dissection was achieved in every patient. The median procedural time stood at 81 minutes, with median intraoperative blood loss limited to only 10 mL and zero perioperative allogeneic blood transfusions administered.

The incidence of Clavien-Dindo grade ≥Ⅲ complications within 30 days postoperatively was 0. Only four patients developed grade Ⅱ complications, including fever, transient ALT elevation (1 case), and blood transfusion (1 case). There were no deaths, readmissions or unplanned outpatient visits. The median length of hospital stay was merely 4 days.

The above data strongly confirm the safety and reliability of the Shurui® SR-ENS-600 single-port surgical robot with snake-like instruments for anatomical lung resection for lung cancer.

Benefiting from the flexible maneuverability of Shurui® dual-continuum snake-like instruments and the rational layout of its original triple-port cannula system, the study achieved excellent minimally invasive surgical outcomes.  Median daily postoperative visual analogue scale (VAS) pain scores remained ≤2 throughout hospitalization (2 on postoperative day [POD] 0, 2 on POD1, 2 on POD2, 1 on POD3, and 1 at discharge). Patient satisfaction survey demonstrated that all patients were willing to undergo surgery using this robotic system again.

The transcostal access strikes an optimal balance between minimal surgical trauma and adequate operative resection.s stated in the original study: “While the subxiphoid approach may reduce pain, it poses greater technical challenges for upper lobectomy. In contrast, our single-port intercostal approach strikes a balance between minimizing trauma and maintaining a clear surgical field, suggesting its analgesic potential is comparable to that of the subxiphoid technique.”

Five Core Technical Innovations Highlighted

Highlight 1: Constrained by its cable-driven multi-joint mechanism, the Da Vinci SP is limited to subxiphoid or subcostal approaches. By contrast, the deformable dual-continuum snake-like instruments of Shurui® enable the feasibility of the intercostal approach.

From a mechanical design perspective, the original article distinguishes two mainstream single-port robotic architectures: cable-driven mechanism  (exemplified by Da Vinci SP) and deformable continuum-based systems (SHURUI SP). The Da Vinci SP requires full articulating instrument shafts to be inserted into the thoracic cavity, demanding extensive intrapleural articulation space and therefore restricting surgeons to subxiphoid or subcostal incisions. Such access complicates upper-lobe resection and raises risks of vascular injury or incomplete lymph node dissection. By comparison, the deformable continuum configuration of the SHURUI SP delivers extended in-vivo workspace and wider articulation angles, drastically simplifying intercostal thoracic dissection.

Highlight 2: The proprietary triple-port trocar enables dexterous multi-instrument coordination and eliminates intraoperative instrument collision.

As described in the original study: “We developed a triple-port cannula specifically designed for thoracic surgery. It consists of a central endoscopic channel, two robotic instrument channels, and an inverted U-shaped inferior structure for auxiliary instruments. This design improves manipulation coordination and efficiency, ensuring safe and effective utilization of the Shurui SP system during complex thoracic procedures.” This configuration allows assistant instruments (suction devices, staplers) to operate via the space beneath the inverted U-shape, while robotic instruments are introduced through curved channels without mutual interference.

Highlight 3: Superelastic Nitinol Alloy Rod Adopted for Snake-Like Instruments, Delivering Flexibility, Power and Stability

As stated in the original study: “Instruments fabricated from superelastic Nitinol rods possess excellent flexibility, force output and stability, enabling precise surgical manipulation.” The system enters the thoracic cavity through the curved-channel trocar and achieves accurate six-dimensional motion during surgery.

Highlight 4: Efficient Multi-quadrant Operation Without Redocking

The original study notes: “The external robotic arm fixation minimizes collision risks and allows trocar repositioning during surgical pauses, enabling efficient multi-quadrant operation without redocking.”

Highlight 5: No additional auxiliary ports were required in any cases, with a conversion rate of zero.

Excerpt from the original study: “All 35 lobectomy and segmentectomy procedures performed using the Shurui SP system were completed successfully without docking or mobility issues upon surgery conclusion. There were no conversions to video-assisted thoracoscopic surgery (VATS) or open surgery, and no extra auxiliary ports were utilized.”

From the perspective of original innovative value, the acceptance and publication of this study in The Annals of Thoracic Surgery marks that the domestically developed single-port robotic system has established differentiated competitiveness against world-leading robotic platforms such as the Da Vinci SP in the field of thoracic surgery. It is of great significance for promoting independent innovation and the international development of minimally invasive thoracic surgical technologies in China.

In terms of academic value, this study represents the world’s first human clinical trial investigating single-port robotic lobectomy and segmentectomy via an intercostal approach. Conducted in strict compliance with clinical trial standards, it fills the evidence gap regarding single-port robotic thoracic surgery using the intercostal access. Its key breakthroughs are summarized as follows:

Innovative surgical approach: Breaking the limitation of the Da Vinci SP system, which is restricted exclusively to subxiphoid and subcostal approaches due to its wire-driven multi-joint instruments, this study validates the clinical feasibility of the intercostal approach applied on a single-port robotic platform.

1. As cited from the manuscript: “The SHURUI SP’s deformable continuum design provides extended working range and broader articulation angles to streamline intercostal thoracic dissection.”
2. Ergonomic Instrument Layout: The patented inverted U-shaped triple-channel trocar establishes a replicable instrumentation layout enabling coordinated work between robotic and bedside instruments within one minimal cutaneous incision, setting a benchmark for complex anatomical lung resection.

2. Instrument coordination innovation: The proprietary inverted U-shaped triple-port cannula enables efficient collaboration between robotic instruments and assistant instruments through a single small incision, establishing an instrument layout paradigm for complex anatomical lung resection.

3. Defined learning curve: Three phases were identified via LC-CUSUM analysis. Phase 1 (first 9 cases) corresponds to the skill acquisition stage; Phase 2 (subsequent 12 cases) features reduced operative time; Phase 3 (Case 21 onwards) marks proficient performance, with operative time stabilized at 79.69 ± 28.42 minutes. This analysis delivers quantifiable reference criteria for the training and popularization of this novel surgical procedure.

Conclusion

Collectively, the Shurui® SR-ENS-600 single-port robotic system demonstrates proven technical feasibility, clinical safety and distinctive minimally invasive advantages for anatomical pulmonary lobectomy and segmentectomy. Head-to-head mechanical and clinical comparison versus Da Vinci SP confirms Shurui’s proprietary dual-continuum snake-like instruments plus customized triple-channel trocar successfully resolves longstanding technical barriers to single-port robotic transcostal thoracic surgery, featuring superior articulation flexibility, enhanced tissue retraction capacity and drastically reduced inter-instrument collision risk.

This technological leap delivers a less invasive, faster-recovering and less painful surgical option for lung cancer patients, while demonstrating world-class capability of China’s homegrown surgical robotics in sophisticated thoracic interventions. The study’s concluding remark affirms: “The SHURUI SP robotic system is safe and feasible for anatomic pulmonary resection.” With ongoing follow-up clinical investigations underway, the Shurui single-port robotic platform is poised to evolve into one of the most minimally invasive therapeutic tools against lung cancer globally, safeguarding human lives worldwide.