Comparative perioperative outcomes of robot-assisted versus video-assisted thoracoscopic mediastinal tumor resection: a propensity score-matched analysis.

OBJECTIVES

To compare perioperative outcomes of robotic-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection in a propensity score-matched cohort.

METHODS

This retrospective study analyzed patients undergoing minimally invasive mediastinal tumor resection between January 2022 and November 2025. Patients were categorized into RATS and VATS groups. Propensity score matching balanced baseline characteristics including age, gender, body mass index, ASA score, Charlson Comorbidity Index, tumor size, tumor location, pathology, and prior thoracic surgery history. The primary outcome was postoperative complications of Clavien-Dindo grade ≥ II. Secondary outcomes included operative time, blood loss, chest tube duration, hospital stay, costs, and pain scores.

RESULTS

After matching, 102 patients (51 per group) were included. RATS was associated with significantly less intraoperative blood loss [median difference - 15 mL (95% CI: - 20 to - 10), P < 0.001], shorter chest tube duration [median difference - 1 day (95% CI: - 1.7 to - 0.3), P = 0.003], and shorter hospital stay [median difference - 1 day (95% CI: - 1.7 to - 0.1), P = 0.009]. Total costs were higher in the RATS group [median difference +$4,400 (95% CI: $3,800-$5,000), P < 0.001]. Operative time, postoperative pain scores, and complication rates (grade ≥ II: 9.8% vs. 13.7%, P = 0.55) were comparable between groups. Using an alternative definition (grade ≥ III), complications occurred in 3.9% (RATS) vs. 5.9% (VATS), P = 0.65.

CONCLUSIONS

For mediastinal tumor resection, RATS offers modest perioperative benefits including reduced blood loss and shorter recovery times compared to VATS, but at substantially higher cost and without a reduction in major complications. RATS is a feasible and safe minimally invasive alternative, but its advantages over VATS are small and must be weighed against economic considerations. Routine adoption is not supported by the current evidence; selection should be individualized.