Comparative meta-analysis of robot- and video-assisted surgery for thymoma: efficacy, learning curve, and economic burden in 7347 patients

Abstract Objective This meta-analysis systematically evaluates the perioperative outcomes, learning curve, and hospitalization costs of robot-assisted thoracoscopic surgery (RATs) compared to video-assisted thoracoscopic surgery (VATs) for thymoma resection. Methods A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, with the final update in June 2025, following PRISMA guidelines. Constant-effects model or random-effects model was used based on heterogeneity, and subgroup analyses were performed accordingly. Results A total of 30 studies involving 7,347 patients (RATs: 3,122; VATs: 4,225) were included, and 17 outcome indicators were analyzed. Compared with VATs, RATs showed lower conversion rates, reduced blood loss, shorter chest tube duration, and fewer complications—including pulmonary infections—while operative time and hospital stay differences were modest. Analysis of the learning curve in 153 RATs patients showed operative times significantly decreased after 20 procedures. Total hospitalization costs were higher for RATs, there were no significant differences in 30-day or 90-day mortality between groups. Conclusion RATs showed favorable perioperative outcomes, including faster recovery and fewer complications, indicating potential clinical advantages in thymoma surgery. Although associated with higher hospitalization costs, further large-scale prospective studies are needed to confirm its broader applicability.