Robotic Thoracic Surgery: Current Landscape and Future Directions.

Area of Science:

• Minimally Invasive Surgery
• Thoracic Surgery
• Surgical Technology

Background:

• Robotic-assisted thoracic surgery (RATS) is now a staple in minimally invasive thoracic procedures.
• Advancements in multi-platform systems, single-port (SP) technology, and artificial intelligence (AI) are driving innovation in surgical precision and patient-specific approaches.

Purpose of the Study:

• To evaluate the current status, benefits, limitations, and future direction of RATS.
• To synthesize evidence from randomized controlled trials (RCTs), observational studies, and technological innovations.

Main Methods:

• Evidence synthesis from RCTs (RVlob, ROMAN, RAVAL-4), national training surveys (SORTS UK), comparative thymic resection series, and SP platform feasibility studies.
• Assessment of technological innovations including AI-driven analytics and SP systems.

Main Results:

• RCTs show oncological equivalence between RATS and video-assisted thoracoscopic surgery (VATS), with potential for higher lymph node yield.
• Structured training is crucial for RATS adoption, and SP platforms show feasibility in high-volume centers but face adoption barriers.
• AI in surgical planning and navigation shows promise, but cost, access, and reproducibility remain challenges.

Conclusions:

• RATS is evolving towards precision oncology, less invasive techniques, and data-driven surgical intelligence.
• Realizing the full potential of RATS necessitates further comparative research, equitable access, and integration into standardized training programs for global adoption.