Comparative Efficacy of Uniportal and Multiportal Robotic-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Background: This study aimed to systematically evaluate the differences in efficacy between uniportal robotic-assisted thoracoscopic surgery (URATS) and multiportal robotic-assisted thoracoscopic surgery (MRATS) for the treatment of non-small cell lung cancer (NSCLC).

Methods: PubMed, Cochrane Library, Web of Science, and Embase were searched from database inception to March 2026 following standardized retrieval procedures. Two authors independently performed literature retrieval, preliminary screening, full-text reassessment, raw data extraction, and cross-checking. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and all statistical analyses were performed using Stata 17.0.

Results: Nine studies involving 1,827 patients were ultimately included. NOS assessment indicated that all included studies were of moderate-to-high quality. The pooled meta-analysis showed that, compared with MRATS, URATS was associated with a longer operative time [weighted mean difference (WMD) = 14.70, 95% confidence interval (95% CI) (6.06, 23.35), P = 0.04, I² = 24.5%] but a shorter length of hospital stay(WMD = -1.07, 95% CI (-1.36, -0.77), P < 0.01, I² = 43.3%). No significant differences were observed in 1-year all-cause mortality, infection, air leak, hemothorax, duration of chest tube drainage, intraoperative blood loss, or number of dissected lymph nodes.

Conclusion: Compared with MRATS, URATS for NSCLC was associated with a longer operative time but a shorter hospital stay, while no statistically significant differences were observed in the other assessed outcomes. These findings suggest that URATS may be a feasible minimally invasive surgical approach for NSCLC, although further prospective studies are warranted. This study has been registered on the INPLASY platform (protocol registration number: INPLASY202670008).