Uniportal Robotic-Assisted Versus Video-Assisted Thoracoscopic Surgery for Anatomical Lung Resection in Non-Small Cell Lung Cancer: A Comparative Single-Center Cohort Study.

Background

Direct comparisons between uniportal robotic-assisted (uRATS) and uniportal video-assisted (uVATS) thoracoscopic anatomical lung resection for non-small cell lung cancer (NSCLC) remain scarce. We compared oncologic radicality and perioperative outcomes between the two uniportal approaches in a single-center contemporaneous cohort.

Methods

This retrospective cohort study included 56 consecutive NSCLC patients undergoing uniportal anatomical resection between January 2024 and December 2025 (uRATS, n = 12; uVATS, n = 44). The primary endpoint was oncologic radicality of lymph-node dissection (stations sampled, total nodes, mediastinal sampling, R0 rate). Secondary endpoints included operative time, blood loss, pain, recovery metrics, and a composite textbook outcome. Comparisons used Mann-Whitney U and Fisher's exact tests.

Results

Complete (R0) resection was achieved in all 56 patients. The operating surgeon dissected more lymph nodes in the uRATS group (median 13 vs. 7; p = 0.049), with a trend toward more mediastinal stations sampled (4 vs. 3; p = 0.061). Operative time was longer with uRATS (220 vs. 135 min; p < 0.001), but air-leak duration (0 vs. 2 days; p < 0.001), hospital stay (2 vs. 3 days; p = 0.022), and discharge pain (p = 0.017) all favored uRATS. Textbook outcome was achieved in 83% versus 48% (p = 0.047).

Conclusions

In a uniportal-experienced unit, uRATS showed comparable intraoperative oncologic-quality metrics to uVATS with directional perioperative-recovery differences favoring uRATS. Larger multicenter studies with longer follow-up are warranted.