Contralateral Robotic-Assisted Anatomical Resection for Synchronous or Metachronous Lung Cancer: A Retrospective Case Series

<b>Background</b>: Advances in screening programs have led to increased detection of early-stage non-small cell lung cancer (NSCLC), including synchronous or metachronous nodules amenable to surgical resection. Patients requiring contralateral anatomical lung resections present a unique surgical challenge due to potential impairments in lung function and the complexities of one-lung ventilation. This study evaluates the feasibility, safety, and perioperative outcomes of robotic-assisted thoracic surgery (RATS) for contralateral anatomical lung resections in patients with NSCLC. <b>Methods</b>: A retrospective analysis was conducted on 20 patients who underwent RATS contralateral anatomical resection between January 2019 and June 2024. Preoperative pulmonary function, perioperative characteristics, and oncological outcomes were assessed. Operative parameters, including conversion rates, intraoperative oxygenation, need for extracorporeal membrane oxygenation (ECMO), and postoperative complications, were recorded. <b>Results</b>: Seventy percent of the patients underwent surgery for metachronous tumors. The median forced expiratory volume in 1 s (FEV1) was 75.94% (66.62-89.24). The most common resection was segmentectomy (65.0%). The median operative time was 148.0 min (108.0-194.75). There were no conversions to open surgery or ECMO requirements. Intraoperative parameters remained stable (median FiO₂: 0.8; lowest SaO₂: 92.0%). Complications occurred in 25% of the patients, mostly Clavien-Dindo grade 2. No in-hospital, 30-day, or 90-day mortality was observed. <b>Conclusions</b>: Robotic-assisted contralateral anatomical lung resection is a feasible and safe approach for patients with previous contralateral surgery, supporting its role as a minimally invasive alternative for complex surgical cases.