回顾性分析全孔道（port-only）人工气胸四臂机器人辅助精准肺段切除术的围手术期疗效与安全性，并结合手术平台特点，探讨其在改善深部术野显露与促进复杂肺段精准切除方面的技术价值。

收集2022年5月至2025年12月在本中心接受全孔道四臂机器人辅助肺段切除术患者的临床资料。所有手术均采用da Vinci Xi机器人系统，在全封闭人工气胸条件下完成。术前依据薄层胸部计算机断层扫描（CT）及三维CT支气管血管成像（3D-CTBA）进行个体化规划；术中结合四臂协同牵拉、马里兰双极钳精细解剖及吲哚菁绿（ICG）荧光显像辅助界定段间平面。主要观察指标包括手术时间、术中估计出血量、中转开胸率、术后引流情况、胸管拔除时间、术后住院时间及术后并发症。

本中心最终纳入271例接受全孔道机器人辅助肺段切除术的患者。患者平均年龄为（58.3±10.3）岁，女性186例（68.6%），有吸烟史69例（25.5%）。术后病理以浸润性腺癌为主，占65.3%，其次为微浸润腺癌，占21.4%。平均手术时间为（117.8±31.0） min，术中估计出血量中位数为40 mL（范围：0~200 mL）。全组仅1例患者中转开胸，中转率为0.4%。术后总引流量为（485.2±440.2） mL，胸管拔除时间为（2.9±1.3）天，术后住院时间为（4.3±1.5）天。胸管留置>7天，4例（1.5%）。淋巴结清扫站数为4.34±2.03，淋巴结清扫数量为（7.07±4.92）枚。R0切除为271例（100%）。其中无术后并发症的有244例（90%），有术后并发症的采用Clavien-Dindo分级，Ⅰ级有23例（8.5%），Ⅱ级有3例（1.1%），术后持续性漏气有1例（0.4%）。

全孔道人工气胸四臂机器人辅助精准肺段切除术在本中心回顾性队列中显示出良好的可行性与围手术期疗效和安全性。其核心价值不仅在于微创切口，更在于主刀医生对镜头臂、操作臂和牵拉臂的集中控制，从而在一定程度上降低术野暴露对助手经验与配合的依赖，减少过程性偏倚；同时借助腕式器械的高自由度与稳定视野，提升深部细血管与段间平面的处理精度，为复杂精准肺段切除提供可复制的技术路径。

To retrospectively evaluate the perioperative outcomes and safety of port-only four-arm robotic-assisted precision pulmonary segmentectomy performed under artificial pneumothorax in a single-center cohort, and to explore the technical value of this approach in improving exposure of the deep operative field and facilitating complex segmental resections.

Clinical data were retrospectively collected from patients who underwent totally portal four-arm robotic-assisted pulmonary segmentectomy at our center between May 2022 and December 2025. All procedures were performed using the da Vinci Xi robotic system under a fully closed artificial pneumothorax. Preoperative individualized planning was based on thin-section computed tomography (CT) and three-dimensional CT bronchography and angiography (3D-CTBA). Intraoperatively, coordinated four-arm traction, meticulous dissection using Maryland bipolar forceps, and indocyanine green (ICG) near-infrared fluorescence imaging were applied to assist in identifying the intersegmental plane. Primary outcomes included operative time, estimated blood loss, conversion to thoracotomy, postoperative drainage parameters, chest tube duration, length of postoperative hospital stay, and postoperative complications.

A total of 271 patients were included. The mean age was (58.3±10.3) years; 186 patients (68.6%) were female, and 69 (25.5%) had a history of smoking. Postoperative pathology revealed invasive adenocarcinoma as the predominant histological type (65.3%), followed by minimally invasive adenocarcinoma (21.4%). The mean operative time was (117.8±31.0) min, and the median estimated blood loss was 40 mL (range, 0–200 mL). One patient (0.4%) required conversion to thoracotomy. The mean postoperative drainage volume was (485.2±440.2) mL, the mean chest tube duration was (2.9±1.3) days, and the mean postoperative hospital stay was (4.3±1.5) days. Chest tube drainage lasting >7 days occurred in 4 patients (1.5%). The mean number of dissected lymph node stations was 4.34±2.03, with a mean of 7.07±4.92 lymph nodes retrieved. R0 resection was achieved in all patients (271/271, 100%). 244 (90.0%) experienced no postoperative complications. Clavien-Dindo grade Ⅰ and grade Ⅱ complications occurred in 23 (8.5%) and 3 (1.1%) patients, respectively, while persistent postoperative air leak was observed in 1 patient (0.4%).

Port-only four-arm robotic-assisted precision pulmonary segmentectomy under artificial pneumothorax is feasible and demonstrates favorable perioperative outcomes and safety in a single-center retrospective cohort. Beyond minimizing surgical incisions, this approach enables centralized control of the camera and traction by the primary surgeon, thereby reducing exposure-related variability associated with assistant-dependent maneuvers. Coupled with wristed robotic instruments, it may improve the precision of deep small-vessel dissection and intersegmental plane management, providing a practical technical strategy for complex precision pulmonary segmentectomy.