Robotic thoracic surgery—current evidence and perspectives: a narrative review

Abstract

Background and Objective: The emergence of robotic surgery as a minimally invasive approach for thoracic procedures has evolved over the past decade. Current understanding of the benefit of this approach has mainly been derived from retrospective studies. The benefits for the surgeon include enhanced three-dimensional vision at the console, dexterity of movements with wristed instrumentation and improved ergonomics. This narrative review summarises the current evidence regarding robotic approach in thoracic surgery. We report operative and clinical outcomes for robotic pulmonary lobectomy, segmentectomy and thymectomy, anaesthetic considerations, and technical advancements. Methods: We performed a literature search using PubMed database of all articles in English, written over the last 10 years from 1st January 2015 to 1st August 2025. Search strategy included the terms ((Robotic surgical procedures OR robotics OR robotic surgery OR robotic assisted surgery) AND (thoracic surgery OR thorax OR mediastinum OR thymectomy OR thoracic surgical procedures OR lung surgery OR thoracic OR lung resection OR lobectomy OR segmentectomy)). We focused on analysing key studies that compared the clinical outcomes of robotic vs. video-assisted approaches, as well as current narrative reviews of robotic thoracic surgery. Key Content and Findings: Robotic thoracic surgery has now become well established among many institutions worldwide. Although there is paucity of high-quality evidence, retrospective studies suggest benefits such as shorter length of stay (LOS), fewer post-operative complications, reduced blood loss and improved lymph node dissection. Few randomised studies have compared robotic to video-assisted approaches. However, these studies are limited by small sample sizes and report heterogeneous data with varying primary endpoints. Conclusions: Robotic thoracic surgery is an evolving minimally invasive approach that has demonstrated safety and efficacy. However, the current evidence is largely limited by the lack of large standardised randomised control trials and long-term outcome data to assess the true benefit over video-assisted thoracoscopic surgery (VATS). Further research is required to define the optimal role of robotic thoracic surgery, balancing clinical benefits with economic considerations.