Abstract
Pleural adhesions can complicate access in robotic cardiac surgery, risking lung injury or conversion to sternotomy. The sliding test using thoracic ultrasound can predict thoracic adhesions and guide the surgeon during robotic set-up. We evaluated the utility of the sliding test in robotic cardiac surgery. The pleural sliding test was performed in 300 consecutive robotic cardiac surgery patients between August 2022 and September 2025. The test was performed by the surgeon using a linear probe at six intercostal sites after intubation. Intraoperative findings were used to validate the test. Tailored port placement and minithoracotomy strategies were used when adhesions were suspected. The mean age was 60.3 ± 13.7 years and 91 (30.3%) of the patients were female. Adhesions were encountered in 20 (6.7%) patients. Prior cardiothoracic surgery was associated with thoracic adhesions (p < 0.001). The pleural sliding test had a sensitivity of 95.0%, specificity of 97.9%, positive predictive value of 76.0%, negative predictive value of 99.6%. No pulmonary injuries occurred and no conversions to sternotomy were necessary in the cohort. Patients with adhesions had higher 24 h chest tube output (p = 0.006) but had similar mechanical ventilation times and intensive care unit stay durations. Pleural adhesions are not rare in patients undergoing robotic cardiac surgery, and their optimal management enhances the safety and efficiency of robotic cardiac procedures. The pleural sliding test offers high accuracy for preoperative detection, enabling tailored access strategies that enhance safety and maintain benefits of the robotic approach.