Chronic Neuralgia After Single‐Port Versus Multiport Trans‐Subxiphoid Robotic Mediastinal Surgery: A Prospective Single‐Arm Pilot Study With Historical Controls

ABSTRACT Purpose To compare postoperative pain and chronic neuralgia between single‐port (SP) and multiport (MP) trans‐subxiphoid robotic approaches in patients with anterior mediastinum disease. Methods In this prespecified secondary analysis of a prospective trial, we compared pain outcomes of patients undergoing SP trans‐subxiphoid robotic surgery for anterior mediastinal disease with those of a historical MP cohort. Acute pain intensity was assessed using the Numeric Rating Scale (NRS) on postoperative days 0, 1 and 2, and at discharge. Chronic neuralgia at 6 months was evaluated with the PainDetect Questionnaire (PDQ). Results Chronic neuralgia occurred in 6.7% (1/15) of the SP group versus 38.9% (7/18) of the MP group ( p = 0.081). Most neuralgia cases in the MP group (6/7) involved multiple domains, whereas the single SP patient experienced only one symptom. Conclusions SP trans‐subxiphoid robotic surgery demonstrated comparable perioperative pain with significantly lower risk of chronic neuralgia. Trial Registration This study represents a prespecified secondary analysis of a prospective clinical trial (ClinicalTrials.gov identifier: NCT05455840)