Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic lung volume reduction surgery

Abstract Objective To compare perioperative outcomes of robotic-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for lung volume reduction surgery (LVRS), focusing on drain duration, hospital stay, postoperative pain, and opioid use. Methodology A retrospective analysis of 38 patients undergoing LVRS (21 RATS, 17 VATS) was performed. comparisons were made for chest drain duration, length of stay (LOS), pain scores, and cumulative opioid consumption (oral morphine-equivalent mg). Baseline parameters (age, sex, preoperative COPD Assessment Test score, six-minute walk test, residual volume, and diffusing capacity for CO were also assessed. An exploratory cost-consequence analysis using institutional costing data and Hospital Episode Statistics was undertaken as a service-evaluation and interpreted cautiously.Birmingham Results Baseline demographics and physiological parameters were broadly similar between groups. Chest-drain duration was significantly shorter in the RATS cohort than in the VATS cohort (4.6 ± 1.9 vs. 10.8 ± 6.1 days, p = 0.002). Length of hospital stay showed a non-significant trend toward shorter stay following RATS (median 8.0 [3.3–10.0] vs. 12.0 [6.0–18.0] days, p = 0.14). Pain scores were comparable at all measured time points. Despite this, opioid use over the first 72 h was significantly lower in RATS (38 ± 12 mg) than in VATS (54 ± 18 mg, p = 0.01). Exploratory health-economic modelling suggested possible cost neutrality, but these estimates should be interpreted as hypothesis-generating only. Conclusion In our retrospective single-center cohort, robotic-assisted LVRS was associated with shorter chest-drain duration, lower early opioid requirement, and a statistically non-significant shorter hospital stay compared with VATS approach, while reported pain scores were similar. These observational findings including the exploratory health-economic analysis, should be confirmed in larger adjusted prospective studies.