Postoperative pain after robotic versus VATS thymectomy: a comparative cohort study

Robotic-assisted thoracoscopic surgery (RATS) is an alternative to video-assisted thoracoscopic surgery (VATS) for thymectomy, but detailed comparisons of postoperative pain, a critical patient-centered outcome, are limited. This study aimed to compare longitudinal pain trajectories and recovery outcomes between RATS and VATS thymectomy.

This retrospective cohort study included 125 consecutive patients who underwent minimally invasive thymectomy (58 RATS, 67 VATS) from 2011 to 2025. The primary endpoints were postoperative pain intensity, measured using serial Numerical Rating Scale (NRS) scores, and the time to pain recovery (NRS ≤ 2). Group comparisons were made using appropriate statistical tests, and a multivariate model was used to adjust for confounders and identify independent predictors for pain recovery.

The RATS group had lower overall NRS scores compared to the VATS group (p < 0.001) and achieved the time to pain recovery (NRS ≤ 2) in a shorter time (log-rank p < 0.001). RATS was also associated with less blood loss and a shorter postoperative hospital stay. Analgesic requirements were lower for the RATS group only during the first three postoperative days (p = 0.004). On multivariate analysis, the RATS approach (Hazard Ratio [HR], 3.28; p < 0.001) and omission of chest tube drainage (HR, 2.42; p = 0.001) were independent predictors of faster pain recovery.

RATS for thymectomy is associated with lower intensity of postoperative pain, leading to a faster recovery compared to VATS. These findings suggest the robotic approach offers superior patient-centered benefits, particularly in the early postoperative period.