Comparative efficacy of uniportal and multiportal robotic-assisted thoracoscopic surgery for non-small cell lung cancer: a systematic review and meta-analysis

Abstract

Background Currently, the comparative efficacy of different robotic surgical systems in the treatment of lung cancer remains unclear. This study aimed to systematically evaluate the differences in efficacy between uniportal robotic-assisted thoracoscopic surgery (URATS) and multiportal robotic-assisted thoracoscopic surgery (MRATS) for the treatment of non-small cell lung cancer (NSCLC). Methods PubMed, Cochrane Library, Web of Science, and Embase were searched from database inception to March 2026 following standardized retrieval procedures. Two authors independently performed literature retrieval, preliminary screening, full-text reassessment, raw data extraction, and cross-checking. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and all statistical analyses were performed using Stata 17.0. This study has been registered on the INPLASY platform (protocol registration number: INPLASY202670008). Results Nine studies involving 1,827 patients were ultimately included. NOS assessment indicated that all included studies were of moderate-to-high quality. The pooled meta-analysis showed that, compared with MRATS, URATS was associated with a longer operative time [weighted mean difference (WMD) =14.70, 95% confidence interval (95% CI): 6.06–23.35, P=0.04, I2=24.5%] but a shorter length of hospital stay (WMD =−1.07, 95% CI: −1.36 to −0.77), P<0.01, I2=43.3%). No significant differences were observed in 1-year all-cause mortality, infection, air leak, hemothorax, duration of chest tube drainage, intraoperative blood loss, or number of dissected lymph nodes. Conclusions Compared with MRATS, URATS for NSCLC was associated with a longer operative time but a shorter hospital stay, while no statistically significant differences were observed in the other assessed outcomes. These findings suggest that URATS may be a feasible minimally invasive surgical approach for NSCLC, although further prospective studies are warranted.