Analgesia in Minimally Invasive Thoracic Surgery: A Comparison Between Robotic Surgery and Video-Assisted Thoracoscopic Surgery.

Background and Objectives: The recent adoption of RATS (robot-assisted thoracic surgery) alongside VATS (video-assisted thoracoscopic surgery) in minimally invasive thoracic surgery highlights the need for comparative evaluation of both techniques regarding postoperative pain and clinical outcomes. This study compared acute postoperative pain within the first 24 h, as well as postoperative complications, 30-day mortality, and length of hospital and ICU stay. Materials and Methods: A retrospective observational study was conducted including all patients scheduled for VATS or RATS at a tertiary hospital between November 2021 and December 2024. Demographic characteristics, surgical procedures, surgical approach, and pain-related outcomes at 24 h (Numeric Rating Scale [NRS], subjective assessment scale, and rescue analgesia) were obtained from the Acute Pain Unit database of the Department of Anesthesiology. Other variables were collected from the electronic medical record. Results: A total of 148 patients were analyzed, of whom 118 underwent VATS and 30 RATS. Surgical duration was significantly longer in the RATS group (130 vs. 218 min, p < 0.05). No significant differences were observed in NRS scores (2.57 ± 1.06 vs. 2.3 ± 0.79, p = 0.195) or subjective pain assessment (good: 78% vs. 83.3%, p = 0.472). RATS required less rescue analgesia in the unadjusted analysis (30.0% vs. 52.5% in VATS, p = 0.022); however, this association was no longer statistically significant after multivariable adjustment (VATS: OR 2.40, 95% CI 0.93-6.25; p = 0.071). There were no significant differences in postoperative complications (17.8% in VATS vs. 16.7% in RATS, p = 0.85), length of hospital stay (4.9 ± 6.2 days in VATS vs. 3.4 ± 3 days in RATS, p = 0.2), or 30-day mortality (0.8% in VATS vs. 0% in RATS, p = 1). ICU length of stay was longer in the RATS group (0.32 ± 0.78 days in VATS vs. 0.73 ± 1.23 days in RATS, p = 0.024). Conclusions: RATS did not demonstrate superiority over VATS in terms of postoperative pain, patient satisfaction, or clinical outcomes.