Robot-assisted vs. video-assisted thoracoscopic surgery in the question of radicality of mediastinal lymphadenectomy

Mediastinal lymphadenectomy plays a crucial role in the surgical treatment of -non-small cell lung cancer (NSCLC), as accurate staging significantly influences subsequent therapy. Robot-assisted thoracoscopic surgery (RATS) has emerged over the past decade as an advanced minimally invasive approach with the potential to achieve high oncological radicality. This review explores the outcomes of mediastinal lymphadenectomy performed using the RATS technique and compares them with those of video-assisted thoracoscopic surgery (VATS). In most studies, a higher, at least comparable, total number of lymph nodes was retrieved with RATS compared to VATS. The number of dissected nodal stations was comparable between RATS and VATS in most studies. Authors frequently highlight the advantages of robotic technology, including enhanced visualization, precise dissection, and the potential to detect occult nodal metastases. The technique is also associated with low morbidity and a feasible learning curve. Although robust long-term survival data are still lacking, current findings suggest that RATS may represent a safe and effective option for mediastinal lymphadenectomy in NSCLC, particularly in centres with established robotic programs.