Uniportal versus multiportal robotic-assisted thoracic surgery pulmonary resections: a propensity score-matched analysis.

Abstract

Background: Uniportal robotic-assisted thoracic surgery (URATS) has been increasingly adopted in some centers; however, its global acceptance and clinical impact remain uncertain. This study compared the perioperative outcomes of URATS and multiportal robotic-assisted thoracic surgery (MRATS) pulmonary resections.

Methods: Eighteen patients who underwent URATS pulmonary resection between February 2023 and April 2024 were compared with 54 patients who underwent MRATS pulmonary resection between February 2016 and February 2023. Propensity score matching, incorporating age, sex, frailty index, clinical tumor size, nodal stage, operative side, prior treatment, and surgical procedure, was performed to reduce confounding. Perioperative outcomes were analyzed in 18 matched patient pairs.

Results: The URATS group had significantly lower analgesic requirements intraoperatively (12.5 [10.5-13.1] vs. 19 [12.3-21.5] mg; P = 0.02) and on the operative day (1.0 [0-3.1] vs. 4.2 [2.0-6.3] mg; P = 0.005). They also had shorter intensive care unit stay (0 [0-0] vs. 1 [0-2] day; P = 0.03) and postoperative hospital stay (4 [2-7] vs. 7 [5-11] days; P = 0.003). However, the docking time was longer in the URATS group than in the MRATS group (11 [8-15] vs. 7 [5-8] min, P = 0.006).

Conclusion: URATS appears to be a feasible approach. Lower analgesic requirements in the immediate postoperative period and shorter hospital stays may indicate improved postoperative recovery compared with MRATS.