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Background <p>Multiportal robotic-assisted thoracic surgery (mRATS) is the standard technique for which robotic systems were originally designed, while uniportal robotic-assisted thoracic surgery (uRATS) combines robotic precision with a single-incision approach. This study provides the first unicentric comparison, evaluating whether uRATS is non-inferior in postoperative recovery and safety.</p> Methods <p>This retrospective cohort study was conducted at a single center and included 402 patients undergoing RATS anatomical pulmonary resections for resectable NSCLC (February 2019–August 2024). Inverse probability weighting was applied to balance baseline characteristics, between uRATS (<i>n</i> = 58) and mRATS (<i>n</i> = 344). Primary endpoint: postoperative complications. Secondary endpoints: operative times, chest drainage duration and hospital stay.</p> Results <p>Complication rates were comparable (uRATS: 39.7%, mRATS: 44.5%, <i>p</i> = 0.588), with prolonged air leak (PAL) being the most frequent (34.0% vs. 34.5%, <i>p</i> = 1.000). Operative times were similar (median 195 vs. 190&#xa0;min, <i>p</i> &gt; 0.05). Recovery metrics, including chest drainage duration (median: 4 days) and hospital stay (4–5 days), showed no significant differences. After adjustment for TNM stage and functional variables, FEV1% emerged as the main predictor of recovery outcomes.</p> Conclusion <p>In this unicentric experience, uRATS and mRATS showed comparable short-term safety and recovery outcomes. uRATS appears to be a feasible alternative, particularly for surgeons familiar with uniportal techniques. Prospective studies are needed to confirm these findings and assess long-term oncological outcomes and patient-centered metrics.</p>

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Advancing minimally invasive thoracic surgery: comparative insights into uniportal and multiportal robotic approaches for non-small cell lung cancer

  • 期刊论文

  • 发表日期：

    2025年11月20日

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  • Inés Serratosa,
  • Carlos Déniz,
  • Iván Macia,
  • Francisco Rivas,
  • Anna Muñoz,
  • Marina Paradela,
  • Samuel García-Reina,
  • Camilo Moreno,
  • Amaia Ojanguren

摘要

Background

Multiportal robotic-assisted thoracic surgery (mRATS) is the standard technique for which robotic systems were originally designed, while uniportal robotic-assisted thoracic surgery (uRATS) combines robotic precision with a single-incision approach. This study provides the first unicentric comparison, evaluating whether uRATS is non-inferior in postoperative recovery and safety.

Methods

This retrospective cohort study was conducted at a single center and included 402 patients undergoing RATS anatomical pulmonary resections for resectable NSCLC (February 2019–August 2024). Inverse probability weighting was applied to balance baseline characteristics, between uRATS (n = 58) and mRATS (n = 344). Primary endpoint: postoperative complications. Secondary endpoints: operative times, chest drainage duration and hospital stay.

Results

Complication rates were comparable (uRATS: 39.7%, mRATS: 44.5%, p = 0.588), with prolonged air leak (PAL) being the most frequent (34.0% vs. 34.5%, p = 1.000). Operative times were similar (median 195 vs. 190 min, p > 0.05). Recovery metrics, including chest drainage duration (median: 4 days) and hospital stay (4–5 days), showed no significant differences. After adjustment for TNM stage and functional variables, FEV1% emerged as the main predictor of recovery outcomes.

Conclusion

In this unicentric experience, uRATS and mRATS showed comparable short-term safety and recovery outcomes. uRATS appears to be a feasible alternative, particularly for surgeons familiar with uniportal techniques. Prospective studies are needed to confirm these findings and assess long-term oncological outcomes and patient-centered metrics.