Single-port robotic segmentectomy using the da Vinci SP system for non-small cell lung cancer

Robot-assisted thoracic surgery using the single-port robotic system is a novel minimally invasive approach; however, clinical data on its use for anatomical segmentectomy remain limited. Therefore, this single-center retrospective cohort study aimed to investigate the safety and feasibility of this technique for segmentectomy by comparing its perioperative outcomes with those of multi-port robot-assisted thoracic surgery and video-assisted thoracoscopic surgery.

Data from patients with non-small cell lung cancer who underwent anatomical segmentectomy from April 2014 to April 2025 were analyzed. Patients were categorized into single-port and multi-port robot-assisted thoracic surgery groups and video-assisted thoracoscopic surgery group according to the surgical approach. Perioperative outcomes were analyzed after propensity score matching.

A total of 345 patients were included in the analysis: single-port robot-assisted thoracic surgery (SP-RATS, n = 50), multi-port robot-assisted thoracic surgery (MP-RATS, n = 75), and video-assisted thoracoscopic surgery (VATS, n = 220). Following matching, 47 patients were included in each group. All patients in the single-port robot-assisted thoracic surgery group underwent complete resection (R0) without conversion to open thoracotomy. In the matched cohort, the SP-RATS group demonstrated a significantly shorter total operative time than that of the MP-RATS group (p < 0.001), whereas no significant difference was observed between the SP-RATS and the VATS groups. In addition, the SP-RATS group had a significantly shorter duration of chest tube drainage than those of the MP-RATS and VATS groups (p = 0.015 and p = 0.039, respectively). No significant differences were observed between groups in terms of postoperative complications, postoperative pain, or pathological outcomes, including the number of harvested lymph nodes.

Robotic segmentectomy using the da Vinci SP system appears safe and feasible, with favorable short-term perioperative outcomes. Large-scale, well-designed prospective trials with long-term follow-up are remained warranted to validate its clinical efficacy.