Minimally invasive segmentectomy for non-small cell lung cancer (NSCLC): a comparative analysis of robotic and thoracoscopic approaches

Anatomical segmentectomy is a lung-sparing surgical option for early-stage non-small cell lung cancer (NSCLC), especially in patients with small peripheral tumors or reduced pulmonary reserve. With increased detection via low-dose CT screening, the demand for segmentectomy is rising. This retrospective cohort study compared short-term outcomes, complications, and costs between robot-assisted segmentectomy (RAS) and video-assisted segmentectomy (VAS) in NSCLC patients. A sum of 603 patients with pathologically confirmed NSCLC who underwent segmentectomy at Xiangya Hospital between May 2020 and June 2024 were included: RAS (n = 302), VAS (n = 301). Both groups were comparable in demographics and baseline characteristics. Intraoperative variables, postoperative recovery indicators, lung function (pre- and postoperative), hemoglobin levels, arterial blood gases, and total cost were analyzed. Statistical significance was set at p < 0.05. No 30-day mortality occurred in either group. RAS showed significantly shorter operation time (89.53 ± 26.60 min vs. 107.80 ± 43.92 min, p < 0.0001), faster intersegmental plane identification (6.10 ± 1.02 min vs. 14.07 ± 2.69 min, p < 0.0001), less blood loss (47.3 ± 39.7 ml vs. 57.3 ± 64.7 ml, p < 0.022), shorter hospital stay (7.9 ± 2.0 vs. 8.5 ± 3.6 days, p < 0.013), chest tube duration (3.3 ± 1.1 vs. 3.6 ± 1.3 days, p < 0.003), and POD1 drainage (257.6 ± 100.4 vs. 282.0 ± 118.4 ml, p < 0.006). RAS had fewer conversions (0.66% vs. 1.3%) and higher lymph node sampling (4.9 ± 0.1 vs. 4.1 ± 0.8, p < 0.0001). Minor (13.57% vs. 19.93%, p < 0.0387) and major (9.60% vs. 12.0%, p < 0.035) complications, postoperative pain (1.65% vs. 7.98%, p < 0.0002), cough, opioid (20% vs. 58%) and antitussive use (20% vs. 46.2%) were lower in RAS. Lung function and ABG values and haemoglobin were statistically similar. Total cost was significantly higher in RAS (9422.3 ± 3183.0 vs. 5741.4 ± 1223.2 USD, p < 0.0001). RAS offers better perioperative outcomes and lower morbidity than VAS but at significantly higher cost, requiring further strategies for cost optimization.