An update on robot-assisted and video-assisted lobectomies for non-small cell lung cancer: a narrative review

Abstract

Background and Objective: Minimally invasive surgical techniques for non-small cell lung cancer (NSCLC) have evolved rapidly, with robot-assisted thoracic surgery (RATS) recently emerging as an alternative to video-assisted thoracoscopic surgery (VATS). There remains a distinct lack of randomized data directly comparing outcomes of RATS, VATS, and open thoracotomy. This narrative review aims to compare the efficacy, safety, and long-term outcomes of RATS and VATS lobectomy for NSCLC. Methods: We conducted a literature review using the PubMed database of studies published between 2000 and 2024, focusing on comparative analyses of RATS and VATS lobectomy for NSCLC. Perioperative outcomes, oncological results, long-term survival data, and cost-effectiveness were evaluated. Key Content and Findings: Recent studies indicate that RATS lobectomy is associated with reduced blood loss, shorter chest tube duration, and lower overall complication rates compared to VATS. RATS may facilitate more extensive lymph node dissection, though the impact on staging and survival remains unclear. Long-term oncological outcomes appear comparable between the two approaches, with some studies suggesting improved disease-free survival (DFS) with RATS. However, RATS is associated with higher costs and longer operating times. Both techniques demonstrate advantages over open thoracotomy in terms of postoperative recovery and pain management. Conclusions: While both RATS and VATS offer benefits over open surgery for NSCLC lobectomy, current evidence does not conclusively demonstrate the superiority of one minimally invasive approach over the other. Larger randomized trials with extended follow-up are needed to definitively compare these techniques. The choice between RATS and VATS should consider institutional experience, patient factors, and cost-effectiveness. As robotic technology continues to evolve, ongoing evaluation of outcomes will be crucial to optimize the surgical management of NSCLC.