Early clinical and economic outcomes of uniportal robotic- and video-assisted thoracoscopic surgery for lung anatomic resection: a retrospective study.

Uniportal video-assisted thoracoscopic surgery (uVATS) is an established minimally invasive approach for lung cancer. Uniportal robotic-assisted thoracoscopic surgery (uRATS) is a recent innovation integrating robotic technology with single-incision access. Comparative data between these techniques remain scarce. We retrospectively analyzed patients who underwent anatomic pulmonary resection via uVATS or uRATS at Chang Gung Memorial Hospital between July 2023 and July 2025. Propensity score matching (1:1) was applied using key baseline variables. Perioperative outcomes and cost-effectiveness were assessed. A total of 356 patients (251 uVATS, 105 uRATS) were included; 98 matched pairs were analyzed. Operative time was longer with uRATS (median 179.50 vs. 117.00 min, p < 0.001). uRATS was associated with shorter hospital stay (2.70 vs. 3.00 days, p < 0.001), reduced chest drainage duration (1.45vs. 2.00 days, p < 0.001), and lower postoperative day 1 pain scores (p = 0.04). Median N1 and N2 lymph node counts were similar in uRATS and uVATS. Postoperative complication rates did not differ significantly between groups (2.04% vs. 9.18%, p = 0.06). Cost analyses quantified the incremental costs associated with short-term recovery benefits of uRATS. uRATS was associated with modest, short-term differences in selected early postoperative recovery parameters compared with uVATS, accompanied by longer operative time and higher cost. Oncologic surrogate outcomes were comparable between groups, while definitive conclusions regarding long-term oncologic and economic benefits require confirmation in larger, multicenter studies with extended follow-up.