Robotic Thoracic Surgery: Current Landscape and Future Directions

Robotic-assisted thoracic surgery (RATS) has transitioned from an emerging adjunct to an established component of minimally invasive thoracic practice. Advances in multi-platform systems, single-port (SP) technology, and artificial intelligence (AI)-driven analytics are shaping the next phase of surgical precision, ergonomics, and patient-specific approaches.

We synthesized evidence from randomized controlled trials (RCTs), observational series, national training initiatives, and recent technological innovations to assess the current status, potential benefits, limitations, and future trajectory of RATS. Data sources included RVlob, ROMAN, and RAVAL-4 RCTs; the SORTS UK national training survey; our own thymic resection comparative series; and SP platform feasibility studies.

RCT data demonstrate oncological equivalence between RATS and video-assisted thoracoscopic surgery (VATS), with some evidence for improved lymph node yield. National survey findings underscore the need for structured training pathways to meet evolving technical demands. Early SP platform experiences indicate feasibility and safety in high-volume centres, but widespread adoption is constrained by limited availability, instrumentation, and independent validation. AI-enhanced surgical planning and intraoperative navigation are promising adjuncts, though their clinical impact remains to be defined. Cost, access inequities, and reproducibility outside expert centres continue to pose challenges.

The trajectory of RATS is towards the integration of precision oncology, less invasive access strategies, and data-driven surgical intelligence. Realizing this vision will require rigorous comparative studies, equitable access, and incorporation into structured training to ensure safe, reproducible, and patient-centred adoption worldwide.