Perioperative outcomes and safety of Uniportal Robotic-Assisted Thoracic Surgery (U-RATS) for anatomic lung resection: a systematic review and meta-analysis

Uniportal robotic-assisted thoracic surgery (U-RATS) represents a recent evolution in minimally invasive lung resection, combining the single-incision philosophy with robotic technology. However, its perioperative safety and outcomes have not been clearly defined across published studies. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and a registered protocol. PubMed, Web of Science, and the Cochrane Library were searched for studies reporting perioperative outcomes of U-RATS for anatomic lung resection in adults. Primary outcomes included conversion rate, morbidity, and mortality. Secondary outcomes were operative time, estimated blood loss, length of hospital stay, and lymph node yield. Random-effects models were applied to pool estimates. Sixteen studies encompassing 579 patients were included. The pooled conversion rate was 1.34% (95% CI: 0.42–4.15%), with no observed heterogeneity. The pooled postoperative morbidity rate was 5.99% (95% CI: 4.46–7.91%), and the pooled mortality rate was 0.21% (95% CI: 0.07–0.64%). The pooled mean operative time was 171.3 min, the estimated blood loss was 51.9 mL, and the postoperative length of stay was 4.9 days. Across 11 studies, the pooled lymph node yield was 16.6 nodes (95% CI: 14.0–19.2; I² = 89.8%). Current evidence suggests that U-RATS is a safe and feasible approach for anatomic lung resection, with low conversion and complication rates and acceptable perioperative outcomes comparable to established minimally invasive techniques.