Objective <p>To predict suitability for robotic surgery from preoperative images in patients with neurogenic tumors at the thoracic apex.</p> Methods <p>This retrospective cohort study included patients who underwent robot-assisted thoracic surgery for tumors at the thoracic apex located cranial to the first rib. Patient characteristics, preoperative computed tomography findings, operative time, operative bleeding, rate of conversion to thoracotomy, and surgical outcomes were reviewed. We examined the image characteristics of converted cases and cases with an operative time exceeding 2&#xa0;h.</p> Results <p>Twenty-five patients underwent robot-assisted thoracic surgery for apical neurogenic tumors, and 64% of these tumors were schwannomas. Ninety-day mortality was 0%; however, postoperative neurological complications were common (Horner’s syndrome: 56%, bronchial plexus disorder: 36%) even after enucleation. However, almost all symptoms disappeared within 1&#xa0;year. Persistent nerve complications were observed in two patients (8%). Tumors &lt; 3&#xa0;cm did not interfere with vessel visualization and were resected within 2 h. Patients with an unconfirmed boundary with the vessels were considered for an anterior transcervical thoracic approach for safety reasons.</p> Conclusions <p>Robot-assisted thoracic surgery for apical neurogenic tumors is feasible; however, postoperative neurological symptoms are common within 1&#xa0;year after surgery. Thoracotomy should be considered for patients with tumors in contact with the subclavian vessels. Preparations for a transmanubrial approach may be necessary for such cases.</p>