Related Experiment Video
Updated: Mar 1, 2026
Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection
Published on: February 7, 2025
Does Robotic Surgery Offer Advantages Over Thoracoscopic Surgery for Patients Undergoing Wedge Resection for
Grace Ha1, Lesley Coe1, Rajika Jindani1
1Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, 10467, United States.
Objectives:
Wedge resection by video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are minimally invasive techniques commonly used in non-small cell lung cancer management. Although RATS has been increasingly adopted for anatomical lung resections, it is unclear whether RATS provides any benefit for simple wedge resection. We sought to compare outcomes using both approaches.
Methods:
The National Cancer Database was used to identify patients with clinical stage IA non-small cell lung cancer who underwent minimally invasive wedge resection between 2010 and 2022. Outcomes were compared between RATS and VATS.
Results:
Of 29 064 patients undergoing wedge resection, 7780 (26.8%) underwent RATS and 21 284 (73.2%) underwent VATS. Robotic-assisted thoracoscopic surgery was associated with greater proportions of patients with 4-10 (41.1% vs 25.4%) and >10 lymph nodes removed (16.5% vs 8.3%) compared to VATS, which was associated with more patients having zero (37.2% vs 18.9%) lymph nodes removed. Correspondingly, RATS was associated with higher odds of nodal upstaging (OR 1.34, CI, 1.14-1.59) and higher delivery of adjuvant therapy (OR 1.37, CI, 1.22-1.55). No significant differences were observed in surgical margins, length of stay, readmissions or short-term mortality. Following propensity score matching, increased lymph node sampling was associated with slightly improved 5-year overall survival (70% vs 66%, P < .001, HR 0.93, 95% CI, 0.89-0.98).
Conclusions:
Robotic-assisted thoracoscopic surgery was associated with increased lymph node yield, which was also associated with slightly improved overall survival after wedge resection, independent of surgical approach. Given the limitations of the National Cancer Database, the relative contributions of increasing RATS adoption versus broader temporal advances in oncological care cannot be distinguished. Further study of more granular details and cost may better inform approach selection.
