Comparative Effectiveness of Robotic vs. Thoracoscopic Segmentectomy in Early-Stage NSCLC

Robotic segmentectomy improved perioperative outcomes but increased per-case cost in early-stage NSCLC. The study's primary endpoints were perioperative outcomes and total hospital cost.

Compared with video-assisted thoracoscopic surgery (VATS) segmentectomy, the robotic platform shortens critical operative steps, lowers conversion and complication rates, and shifts the operative risk–benefit calculus. The technique requires dedicated training, robotic credentialing, and OR scheduling adjustments. High-volume thoracic centers capture the largest marginal gains; lower-volume programs face steeper learning curves and higher fixed costs, so surgeons must weigh whether local adoption is justified.

Perioperatively, robotic cases had shorter operative time (mean 89.53 ± 26.60 min vs. 107.80 ± 43.92 min), reduced intraoperative blood loss (47.3 ± 39.7 ml vs. 57.3 ± 64.7 ml), fewer conversions (0.66% vs. 1.3%), and shorter length of stay (7.9 ± 2.0 vs. 8.5 ± 3.6 days). Chest tube duration and POD1 drainage were also reduced, and both minor (13.6% vs. 19.9%) and major (9.6% vs. 12.0%) complication rates were lower with the robotic technique. These differences indicate reduced morbidity and faster recovery with potential gains in OR and bed-day throughput.

For staging and oncologic adequacy, robotic resections sampled more lymph nodes (4.9 ± 0.1 vs. 4.1 ± 0.8), improving pathologic staging granularity relevant to adjuvant therapy decisions. Short-term oncologic outcomes were comparable between groups, with no 30-day mortality and similar postoperative lung-function metrics, supporting oncologic adequacy of lung-sparing segmentectomy when performed robotically in experienced hands.

These perioperative and staging benefits must be balanced against cost: the study (retrospective cohort, 2018–2023) reported mean total hospital cost for the robotic approach of $9,422.3 ± 3,183.0 versus $5,741.4 ± 1,223.2 for VATS segmentectomy (hospital accounting total costs, USD, year 2023), roughly a 64% higher per-case expense.