Abstract
OBJECTIVE: To compare the short-term outcomes of multi-arm uniportal robotic-assisted thoracoscopic surgery (URATS) and multiport robotic-assisted thoracoscopic surgery (MRATS) and to evaluate the safety and feasibility of URATS. METHODS: A retrospective analysis was conducted on clinical data from patients who underwent robotic-assisted thoracoscopic surgery in the Department of Thoracic Surgery II at Xinjiang Tumor Hospital between May 2023 and January 2025. Patients were categorized into the URATS and MRATS groups based on the surgical approach. A 1:1 propensity score matching (PSM) analysis was performed according to the clinical characteristics of the patients, and the short-term outcomes were compared between the two groups. RESULTS: A total of 353 patients were included in this study, comprising 153 patients in the URATS group and 200 patients in the MRATS group. After PSM, each group consisted of 115 patients. The intraoperative blood loss in the URATS group was significantly lower than that in the MRATS group [median blood loss: 50 (30,100) mL vs. 100 (50,100) mL; P < 0.001]. The incidence of postoperative complications was lower in the URATS group compared to the MRATS group (5.2% vs. 10.4%, P = 0.041). The median duration of chest tube drainage was longer in the URATS group than in the MRATS group [4 (3,5) days vs. 3 (3,4) days, P = 0.003], and the median postoperative hospital stay was also slightly longer in the URATS group than in the MRATS group [5 (4,6) days vs. 4 (4,5) days, P = 0.037]. No significant differences were observed between the two groups in other perioperative parameters (P > 0.05). CONCLUSION: For pulmonary resection and mediastinal tumor resection, URATS demonstrates perioperative outcomes comparable to those of MRATS, with favorable safety and feasibility. URATS not only minimizes access-related surgical trauma but also results in a lower incidence of postoperative complications. Furthermore, it offers superior postoperative cosmetic outcomes, making it a promising technique for clinical application.