High-intensity theatre lists for robot-assisted major thoracic resection: A proof of concept in the era of lung cancer screening

Newly published data from the NHS Targeted Lung Health Check (TLHC) programme confirm that over 75% of screen-detected lung cancers are now diagnosed at stage I or II, a shift that has already driven a 20% annual increase in resections, from 6547 in 2023 to 7878 in 2024. With the programme set to perform nearly one million annual scans by 2030, resection demand will continue to rise steeply. Scaling surgical throughput within existing theatre infrastructure, without opening new units, is therefore both an operational and oncological priority. The High-Intensity Theatre (HIT) list model, a structured, back-to-back operating framework that uses parallel anaesthetic pathways, has transformed throughput in urology and general surgery but had not been applied to major anatomical thoracic resection. We describe the first two HIT lists for robot-assisted thoracic surgery (RATS) at a high-volume UK centre. Fifteen patients underwent major anatomical resection across two lists, including lobectomies, bilobectomy, and complex segmentectomies. All 15 resections achieved R0 status. Median console time was 35 minutes. Thirty-day mortality was nil. Five patients (33%) developed complications, consistent with published RATS benchmarks. These early data suggest that the HIT model is feasible for high-complexity thoracic surgery, with an acceptable early safety profile, and that it may offer a replicable, cost-neutral way to help protect curative intent at population scale. As this is a small, single-centre proof-of-concept series with no control group, it establishes feasibility rather than efficacy.