Single-port robotic thoracic surgery: a systematic review and meta-analysis of comparative outcomes versus multiport robotic surgery and uniportal VATS.
Andrei I Gritsiuta, Joshua Yazditabar, Parsa Radfar et al.
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In 30 seconds
This systematic review and meta-analysis compared single-port robotic-assisted thoracic surgery (SP-RATS) with multiport robotic surgery (MP-RATS) and uniportal video-assisted thoracoscopic surgery (uVATS). Sixty reports were included, of which 23 contributed comparative data. Outcomes were broadly similar between SP-RATS and MP-RATS; versus uVATS, SP-RATS was associated with shorter chest-tube duration (mean difference, -0.49 days; 95% CI, -0.85 to -0.13; P = 0.013). Complications, R0 resection, and mortality did not differ significantly. Evidence certainty was low or very low across pooled outcomes.
Key findings
- Compared with MP-RATS, SP-RATS had broadly similar perioperative outcomes; lymph-node yield was nominally lower (MD, - 1.18 nodes; 95% CI, - 2.31 to - 0.05; P = 0.043), but this was not robust in sensitivity analyses.
- Compared with uVATS, SP-RATS was associated with shorter chest-tube duration (MD, - 0.49 days; 95% CI, - 0.85 to - 0.13; P = 0.013).
- Complications, R0 resection, and mortality did not differ significantly between approaches.
- Certainty of evidence was low or very low across all pooled outcomes.
Why it matters
The findings suggest that reducing robotic access to a single port may be feasible without an evident loss in perioperative safety or immediate oncologic outcomes. The shorter chest-tube duration versus uVATS is a potentially relevant recovery signal, but the low certainty and sensitivity of some results mean comparative benefits remain uncertain.
What to keep in mind
Evidence certainty was low or very low across pooled outcomes, and some favorable findings were not consistent across sensitivity analyses. The review calls for prospective comparative studies.