Comparative effectiveness of robotic and video assisted thoracic surgery for lung cancer across key outcomes

Robotic-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) are widely used for minimally invasive resection of pulmonary tumors, but they differ in technical capabilities and resource demands. We conducted a PRISMA-based systematic review and meta-analysis of randomized and cohort studies identified by searching PubMed, Embase, Web of Science, Scopus, and the Cochrane Library through June 2025. Across 25 studies including 41,417 patients, RATS was associated with lower conversion to thoracotomy rates and less blood loss, more extensive lymphadenectomy, higher R0 resection rates, and shorter chest tube duration, ICU stay, and hospital stay. Pneumonia and atrial fibrillation were less frequent, whereas overall complications, pneumothorax, and 30- and 90-day mortality were similar. Hospitalization costs were higher, and pooled survival data suggested a possible long-term advantage. These findings clarify platform tradeoffs and motivate large randomized trials and cost-effectiveness analyses.