Transitioning from multiport to uniport robot-assisted thoracic surgery: a propensity score-weighted evaluation of safety and feasibility.

BACKGROUND: The present study assessed the safety and feasibility of uniport robot-assisted thoracic surgery (RATS) during a structured transition from conventional multiport to uniport RATS. METHODS: Patients undergoing RATS pulmonary resection for non-small cell lung cancer between June 2022 and December 2025 were included in this retrospective analysis. Perioperative outcomes were evaluated according to surgical approach (uniport vs. multiport). To address potential baseline differences between the groups, inverse probability of treatment weighting (IPTW) based on propensity scores was employed. RESULTS: The study cohort comprised 154 patients, with all operations performed by a single surgeon. Of these, 53 (34.4%) underwent uniport RATS and 101 (65.6%) underwent multiport RATS. After IPTW adjustment, baseline variables were adequately balanced across the groups. Complete resection was achieved in all cases, with one conversion in the multiport group. The surgical extent, histologic type, and lymph node assessment were comparable between groups. In our series, operative duration was shorter among patients undergoing uniport RATS both before (131.5 ± 23.4 vs. 145.8 ± 43.9 min, P = 0.037) and after IPTW (130.1 ± 23.0 vs. 147.3 ± 46.2 min, P = 0.004). Duration of chest drainage, postoperative hospital day, and complication rates were similar between groups. Patients in the uniport RATS group reported lower postoperative pain scores on postoperative days 0-2, and this difference remained significant in both the crude and IPTW-weighted analyses (all P < 0.05). CONCLUSIONS: Within a structured transition pathway, uniport RATS achieved perioperative outcomes and early oncologic feasibility comparable to those of multiport RATS, supporting its safety and technical applicability.