Advantages and disadvantages of robotic and uniportal video-assisted thoracoscopic surgery

Robotic-assisted thoracoscopic surgery (RATS), which aims to increase accuracy, and uniportal video-assisted thoracoscopic surgery (U-VATS), which aims to decrease invasiveness, have been reported as new surgical methods for pulmonary resection. The advantages of robotic-assisted surgery include a three-dimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. Therefore, it allows some surgeries that are not feasible with the manual thoracoscopic techniques performed by human hands available currently. Its disadvantages include the lack of tactile sensation, an increased number of ports, the high cost, and unproven commensurate patient benefits. The advantages of uniportal surgery include a lower level of postoperative pain and faster patient recovery because of the single incision, whereas the fact that all surgical instruments are inserted via a single incision, thereby limiting surgical manipulation and decreasing surgical safety and accuracy, represents a disadvantage of this technique. Although many reports have indicated that both robotic-assisted surgery and uniportal surgery are more useful than conventional thoracoscopic surgery, sufficient demonstration based on a high level of evidence remains to be achieved. In the future, the safety, level of invasion, and oncological long-term results of these new surgical methods should be compared with those of conventional surgical methods and investigated regarding their utility.