Advancing minimally invasive thoracic surgery: comparative insights into uniportal and multiportal robotic approaches for non-small cell lung cancer.

BACKGROUND

Multiportal robotic-assisted thoracic surgery (mRATS) is the standard technique for which robotic systems were originally designed, while uniportal robotic-assisted thoracic surgery (uRATS) combines robotic precision with a single-incision approach. This study provides the first unicentric comparison, evaluating whether uRATS is non-inferior in postoperative recovery and safety.

METHODS

This retrospective cohort study was conducted at a single center and included 402 patients undergoing RATS anatomical pulmonary resections for resectable NSCLC (February 2019-August 2024). Inverse probability weighting was applied to balance baseline characteristics, between uRATS (n = 58) and mRATS (n = 344).

PRIMARY ENDPOINT: postoperative complications. Secondary endpoints: operative times, chest drainage duration and hospital stay.

RESULTS

Complication rates were comparable (uRATS: 39.7%, mRATS: 44.5%, p = 0.588), with prolonged air leak (PAL) being the most frequent (34.0% vs. 34.5%, p = 1.000). Operative times were similar (median 195 vs. 190 min, p > 0.05). Recovery metrics, including chest drainage duration (median: 4 days) and hospital stay (4-5 days), showed no significant differences. After adjustment for TNM stage and functional variables, FEV1% emerged as the main predictor of recovery outcomes.

CONCLUSION

In this unicentric experience, uRATS and mRATS showed comparable short-term safety and recovery outcomes. uRATS appears to be a feasible alternative, particularly for surgeons familiar with uniportal techniques. Prospective studies are needed to confirm these findings and assess long-term oncological outcomes and patient-centered metrics.