Perioperative outcomes of uniportal robotic-assisted thoracic surgery (U-RATS) for lung resection: state of the art—a narrative review

Abstract

Background and Objective: Uniportal robotic-assisted thoracic surgery (U-RATS) combines the experiences gathered from the two contemporary thoracic surgical methods, uniportal video-assisted thoracoscopic surgery (U-VATS) and robotic-assisted thoracic surgery (RATS). The goal is to minimise invasiveness, reduce operative time and alleviate pain as much as possible, thereby leading to quicker postoperative recovery and shorter hospital stay. We conducted a review of the current literature of the U-RATS for lung resection to determine if the aims are being achieved. Methods: We conducted an electronic-based literature search on PubMed to identify original articles published in any language up to 15 June 2024, reporting on peri- and postoperative clinical outcomes of U-RATS for lung resections. We prioritised cohorts or case series for the focus of this review. Key Content and Findings: The search strategy yielded 8 relevant studies that were identified and included for this review. A total of 354 patients (60.2% males) split across the 8 cohort studies and case reports were identified. Mean operation time varied between 76.0 and 216.0 minutes. The mean length of stay varied between 3.8 and 6.8 days. In 4 of the 8 studies, the mean blood loss was 25.0–131.7 mL. In 2 of the 8 studies, short-term post-operative pain scores in U-RATS was significantly lower compared to other minimally invasive thoracic surgical techniques. Conclusions: Initial perioperative outcomes of U-RATS approach are safe, feasible and efficacious when performed by expert surgeons. However, the evidence is still limited as there are only a few published studies, the overwhelming majority being retrospective, single-centre and short-term perioperative outcomes focused. In the future more randomised, prospective, and multicentred, multi-surgeon and long-term clinical and oncological follow-up studies are needed to report the results of the U-RATS approach as well as studies comparing it to other minimally invasive thoracic surgical techniques.