Comparison of efficacy and costs between robotic-assisted and conventional thoracoscopic approaches for partial pulmonary resection: a systematic review and meta-analysis of propensity score-matched studies.

Background: This meta-analysis aimed to evaluate differences in perioperative outcomes and costs between robotic-assisted partial pulmonary resection (RAPPR) and video-assisted thoracoscopic partial pulmonary resection (VATPPR). Methods: We systematically searched MEDLINE, PubMed, Google Scholar, and Cochrane databases for relevant studies published between March 2015 and March 2025. Propensity score-matched non-randomized controlled studies comparing RAPPR with VATPPR were included. Results: Eight propensity score-matched studies involving 3,104 patients were included: 1,528 patients underwent RAPPR and 1,576 underwent VATPPR. RAPPR was associated with longer operative time and higher medical costs, but patients had more lymph nodes dissected, shorter drainage tube duration, and shorter hospital length of stay. No significant differences were observed between the two groups in conversion to thoracotomy rates or complication rates, including persistent air leak, pneumonia, and chylothorax. Conclusions: RAPPR demonstrates comparable surgical efficacy to VATPPR with advantages including more thorough lymph node dissection, earlier drainage tube removal, and earlier patient discharge. However, RAPPR requires longer operative time and higher costs. The choice between surgical approaches should consider these clinical factors comprehensively.