Uniportal video-assisted lung resection versus robotic-assisted lung resection, is there a difference?

Background: There has been increasing adoption of robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (uVATS) for lung resection. We undertook a single-institution retrospective study, comparing these approaches.

Methods: An analysis was performed of patients who underwent lung resection by either uVATS or RATS. Operations were performed between July 1, 2020 and July 1, 2021. Two surgeons [one experienced in RATS, the other experienced in multi-portal VATS (mVATS), with the recent adoption of uVATS] performed all operations. Patients with known or suspected lung cancer or metastases were included. In addition to baseline characteristics, adverse events [as defined in the Society of Thoracic Surgeons (STS) General Thoracic Database], subjective pain scores (scale 1-10), and morphine equivalent dose (MED) requirement were compared for patients who remained in the hospital on post-operative days (POD) 1 to 4. For patients with lung cancer, recurrence rates, overall survival, and recurrence-free survival were evaluated.

Results: There were 128 (50 uVATS and 78 RATS) patients. Although uVATS patients were older (70 versus 65 years; P=0.01), there was no difference in baseline forced expiratory volume in the first second (FEV₁)%, diffusing capacity for carbon monoxide (DLCO)%, body mass index, and American Society of Anesthesiologists (ASA) scores. Mean procedure times and adverse event rates were similar. Four major complications occurred (all unanticipated return to the operating room). The 30- and 90-day mortality was zero. RATS was associated with shorter hospital stay (2.6 versus 4 days; P=0.02) and improved lymph node (15.3 versus 9.9; P=0.003) dissection. MED requirement was significantly reduced on POD 2-4 after uVATS, on both univariate and multivariate analysis. Ninety-four patients (uVATS; n=38, RATS; n=56) had primary lung cancer. Median follow-up was 15.6 months for these patients. Recurrence occurred in 4/34 (11.8%) uVATS and 7/56 (12.5%) RATS patients (P=0.77). There were no differences in overall survival or time to recurrence.

Conclusions: UVATS and RATS lung resections were associated with similar post-operative adverse event rates. Lymph node dissection and length of stay were improved with RATS. Oncological outcomes were similar. UVATS was associated with lower morphine requirement. Prospective studies will help further clarify the differences between these approaches.