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<p>Minimally invasive surgery (MIS) has become a cornerstone in thoracic surgical practice, providing significant benefits over traditional thoracotomy, including reduced postoperative pain and faster recovery. Robotic-assisted thoracic surgery (RATS) represents the latest evolution of MIS, offering enhanced dexterity and precision compared with video-assisted thoracic surgery (VATS). This retrospective study analyzed perioperative outcomes following the introduction of a RATS program for non-small cell lung cancer (NSCLC) at a single institution already experienced in VATS. Data from 298 patients who underwent minimally invasive anatomical lung resections between January 2020 and December 2022 were reviewed. Among them, 205 (68.8%) underwent VATS and 93 (31.2%) underwent RATS. The overall complication rate was 29.9%, with a 1.0% 30-day and 0.3% 90-day mortality. RATS procedures were initially associated with longer operative times but demonstrated significantly fewer severe postoperative complications (Clavien-Dindo grade III–IV, <i>p</i> = 0.011). After the learning curve phase (first 50 cases), operative times became comparable between RATS and VATS, while the robotic approach was associated with shorter hospital stays and no major complications. Multivariable analysis confirmed RATS as independently associated with lower odds of severe complications (OR 0.17; <i>p</i> = 0.026). Length of stay showed a non-significant trend favoring RATS. These results indicate that RATS can be safely and effectively integrated into an established VATS program. Progressive experience reduces operative time and complication rates, confirming RATS as a feasible and safe addition to minimally invasive thoracic surgery in a real-world clinical setting.</p>

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Safe transition to robotics: How an established program on vats shapes postoperative outcomes in lung resection

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Matteo Petroncini,
  • Pietro Bertoglio,
  • Elena Garelli,
  • Kenji Kawamukai,
  • Jury Brandolini,
  • Piergiorgio Solli

摘要

Minimally invasive surgery (MIS) has become a cornerstone in thoracic surgical practice, providing significant benefits over traditional thoracotomy, including reduced postoperative pain and faster recovery. Robotic-assisted thoracic surgery (RATS) represents the latest evolution of MIS, offering enhanced dexterity and precision compared with video-assisted thoracic surgery (VATS). This retrospective study analyzed perioperative outcomes following the introduction of a RATS program for non-small cell lung cancer (NSCLC) at a single institution already experienced in VATS. Data from 298 patients who underwent minimally invasive anatomical lung resections between January 2020 and December 2022 were reviewed. Among them, 205 (68.8%) underwent VATS and 93 (31.2%) underwent RATS. The overall complication rate was 29.9%, with a 1.0% 30-day and 0.3% 90-day mortality. RATS procedures were initially associated with longer operative times but demonstrated significantly fewer severe postoperative complications (Clavien-Dindo grade III–IV, p = 0.011). After the learning curve phase (first 50 cases), operative times became comparable between RATS and VATS, while the robotic approach was associated with shorter hospital stays and no major complications. Multivariable analysis confirmed RATS as independently associated with lower odds of severe complications (OR 0.17; p = 0.026). Length of stay showed a non-significant trend favoring RATS. These results indicate that RATS can be safely and effectively integrated into an established VATS program. Progressive experience reduces operative time and complication rates, confirming RATS as a feasible and safe addition to minimally invasive thoracic surgery in a real-world clinical setting.