Early results of robotic versus uniportal video-assisted thoracic complex segmentectomy: a propensity score-matched study.

BACKGROUND/PURPOSE: Robotic-assisted thoracoscopic surgery (RATS) has increasingly been adopted in thoracic surgery, yet direct comparisons with uniportal video-assisted thoracoscopic surgery (uVATS) for complex segmentectomy remain limited. We compared early perioperative outcomes between RATS and uVATS for complex pulmonary segmentectomy.

METHODS

Patients undergoing complex segmentectomy between 2023 and 2025 were reviewed. Complex segmentectomy was defined as resection of any segment other than the bilateral superior segment of the lower lobes, lingular, or superior segment of the left upper lobe. After the RATS learning curve, a 1:1 propensity score matching was performed based on age, sex, ASA classification, BMI, and specific segmentectomy procedures, yielding 81 matched pairs in each group.

RESULTS

RATS was associated with a significantly longer skin-to-skin operative time (133 vs. 92 min; P < 0.001) and higher self-paid costs (USD 5,899 vs. 2,557; P < 0.001). Chest drainage duration and length of hospital stay were comparable between the groups. Major morbidity occurred less frequently in the RATS group (0.0% vs. 7.4%; P = 0.031), although prolonged air leak itself did not significantly differ between groups (0.0% vs. 6.2%; P = 0.063). RATS was also associated with greater N2 nodal dissection and a higher number of lymph nodes retrieved (median 7 vs. 2; P < 0.001). No conversions or in-hospital mortality occurred.

CONCLUSION

RATS provides comparable short-term safety for complex segmentectomy. Although it is associated with longer operative time and increased financial burden, RATS may offer potential advantages in reducing major morbidity. These findings support the selective use of RATS for anatomically complex or high-risk cases. Further studies should assess long-term oncologic outcomes and cost-effectiveness.