Uniportal versus multiportal robotic-assisted thoracic surgery for anatomical pulmonary resection: a systematic review and meta-analysis of perioperative recovery and surgical quality.
Anas B Barnawi, Muhanad Sultan Alsharari, Hamad Saleh Alanazi et al.
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In 30 seconds
This systematic review and meta-analysis compared uniportal/single-port with multiportal robotic-assisted thoracic surgery for anatomical pulmonary resection. It included nine non-randomised studies involving 813 patients; seven studies were rated at critical risk of bias. Postoperative complications were reported in 16.0% versus 30.2%, respectively, but the pooled difference was not statistically significant (RR 0.49, 95% CI 0.22-1.06; p = 0.069; I²=66%). No clear differences emerged in perioperative safety or surgical quality. Uniportal surgery was associated with shorter console time and slightly lower day-1 pain, findings the authors considered very-low-certainty and sensitive to individual studies.
Key findings
- Postoperative complications occurred in 16.0% of uniportal and 30.2% of multiportal patients; the pooled difference was not statistically significant (RR 0.49, 95% CI 0.22-1.06; p = 0.069; I²=66%).
- Uniportal surgery was associated with shorter console time (MD - 23.5 min, 95% CI - 35.6 to - 11.4).
- Day-1 pain was lower with uniportal surgery (MD - 0.6 points, 95% CI - 0.9 to - 0.3), but the difference was below commonly used thresholds for clinical importance and lost statistical significance when digitised values were excluded (p = 0.092).
- No significant differences were identified in major complications, conversion, mortality, operative time, blood loss, chest-tube duration, length of stay, lymph-node yield, or R0 resection.
Why it matters
The review addresses whether reducing port number in robotic anatomical lung resection improves recovery without compromising safety or surgical quality. Its findings do not establish a clear perioperative advantage for either approach. The possible gains in console time and early pain are modest or uncertain, so they should be interpreted alongside the substantial risk of bias and very-low certainty of the available evidence.
What to keep in mind
All nine included studies were non-randomised, and seven were rated at critical risk of bias. The complication estimate was heterogeneous, and pain and console-time findings were sensitive to individual studies.