Uniportal versus multiportal robotic-assisted thoracic surgery for anatomical pulmonary resection: a systematic review and meta-analysis of perioperative recovery and surgical quality.

Uniportal robotic-assisted thoracic surgery (uRATS) seeks to combine the dexterity of robotic platforms with reduced access trauma, yet its comparative value over multiportal RATS (mRATS) remains uncertain. We systematically evaluated perioperative recovery and surgical quality after anatomical pulmonary resection. PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched through 2026. Comparative studies of uniportal/single-port versus multiportal robotic anatomical lung resection were included. Random-effects meta-analyses pooled risk ratios (RRs) and mean differences (MDs). Risk of bias was assessed using ROBINS-I V2 and certainty of evidence using GRADE. Nine non-randomised studies involving 813 patients were included, with seven studies rated at critical risk of bias. Postoperative complications occurred in 16.0% of uniportal and 30.2% of multiportal patients, with no statistically significant pooled difference (RR 0.49, 95% CI 0.22-1.06; p = 0.069; I²=66%). No significant differences were identified in major complications, conversion, mortality, operative time, blood loss, chest-tube duration, length of stay, or lymph-node yield, or R0 resection. Uniportal surgery was associated with shorter console time (MD - 23.5 min, 95% CI - 35.6 to - 11.4) and lower postoperative day-1 pain (MD - 0.6 points, 95% CI - 0.9 to - 0.3). The 0.5- point pain difference was below commonly used thresholds for clinical importance and lost statistical significance when digitised values were excluded (p = 0.092). Available observational evidence does not demonstrate a clear difference in perioperative safety or surgical quality between uniportal/single-port and multiportal robotic-assisted thoracic surgery. Exploratory subgroup analyses suggested differences in length of stay and operative time by comparator port count, potentially reflecting confounding by operative era and experience. A possible reduction in console time and early postoperative pain was observed, but these findings were based on very-low-certainty evidence and were sensitive to individual studies.