---
title: "Uniportal versus multiportal robotic thoracic surgery: perioperative recovery and surgical quality"
id: "pubmed-42920010"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42920010"
content_type: "clinical_feed_article"
specialty: "Pulmonology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42920010/"
doi: "10.1007/s11701-026-04105-x"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Uniportal versus multiportal robotic thoracic surgery: perioperative recovery and surgical quality
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42920010
- **Specialty:** [Pulmonology](https://medichelpline.com/clinical-feed/pulmonology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42920010/)
- **DOI:** [10.1007/s11701-026-04105-x](https://doi.org/10.1007%2Fs11701-026-04105-x)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The review compared **uniportal robotic-assisted thoracic surgery** (uRATS) with multiportal robotic-assisted thoracic surgery (mRATS) for **anatomical pulmonary resection** using systematic review and meta-analysis methods. - Investigators searched PubMed/MEDLINE, Web of Science, and the Cochrane Library through 2026 and included comparative studies of uniportal/single-port versus multiportal robotic anatomical lung resection. - Nine non-randomised studies were pooled, totaling 813 patients; seven studies were rated at critical risk of bias using ROBINS-I V2. - Postoperative complications occurred in 16.0% of uniportal and 30.2% of multiportal patients; pooled RR was 0.49 (95% CI 0.22–1.06; p = 0.069; I² = 66%), a non-significant difference. - No significant pooled differences were observed for major complications, conversion, mortality, operative time, blood loss, chest-tube duration, length of stay, lymph-node yield, or R0 resection. - The review reported shorter console time with uniportal approaches (MD −23.5 min, 95% CI −35.6 to −11.4) and lower day‑1 pain scores (MD −0.6 points, 95% CI −0.9 to −0.3), although the pain difference did not meet common clinical thresholds and lost significance in sensitivity testing. - Certainty of evidence was assessed with GRADE and judged very low for key findings; results were sensitive to individual studies and confounding by operative era and experience was plausible. - The authors concluded currently available observational data do not demonstrate a clear perioperative safety or surgical-quality advantage for uniportal over multiportal robotic approaches. - Protocol registration was reported (PROSPERO CRD420261432924).
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. anbarnawi@gmail.com. * 2 College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. * 3 Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. * PMID: **42920010** * DOI: [ 10.1007/s11701-026-04105-x ](https://doi.org/10.1007/s11701-026-04105-x) Item in Clipboard Meta-Analysis # 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 et al. J Robot Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID J Robot Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Robot+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Robot+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) . 2026 Oct 24;20(1):1130. doi: 10.1007/s11701-026-04105-x. ### Authors [Anas B Barnawi](https://pubmed.ncbi.nlm.nih.gov/?term=Barnawi+AB&cauthor_id=42920010)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-1 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia. anbarnawi@gmail.com."), [Muhanad Sultan Alsharari](https://pubmed.ncbi.nlm.nih.gov/?term=Alsharari+MS&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Hamad Saleh Alanazi](https://pubmed.ncbi.nlm.nih.gov/?term=Alanazi+HS&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Razan Mohammed Alshehri](https://pubmed.ncbi.nlm.nih.gov/?term=Alshehri+RM&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Saja Abdullah Alasiri](https://pubmed.ncbi.nlm.nih.gov/?term=Alasiri+SA&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Lamia Alharbi](https://pubmed.ncbi.nlm.nih.gov/?term=Alharbi+L&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Norah Saud Almabkhut](https://pubmed.ncbi.nlm.nih.gov/?term=Almabkhut+NS&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Nouf Rashed Abuniyan](https://pubmed.ncbi.nlm.nih.gov/?term=Abuniyan+NR&cauthor_id=42920010)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-2 "College of Medicine, Imam Mohammad Ibn Saud Islamic University \(IMSIU\), Riyadh, Saudi Arabia."), [Waseem M Hajjar](https://pubmed.ncbi.nlm.nih.gov/?term=Hajjar+WM&cauthor_id=42920010)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920010/#short-view-affiliation-3 "Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.") ### Affiliations * 1 College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. anbarnawi@gmail.com. * 2 College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. * 3 Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. * PMID: **42920010** * DOI: [ 10.1007/s11701-026-04105-x ](https://doi.org/10.1007/s11701-026-04105-x) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Uniportal robotic-assisted thoracic surgery (uRATS) seeks to combine the dexterity of robotic platforms with reduced access trauma, yet its comparative value over multiportal RATS (mRATS) remains uncertain. We systematically evaluated perioperative recovery and surgical quality after anatomical pulmonary resection. PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched through 2026. Comparative studies of uniportal/single-port versus multiportal robotic anatomical lung resection were included. Random-effects meta-analyses pooled risk ratios (RRs) and mean differences (MDs). Risk of bias was assessed using ROBINS-I V2 and certainty of evidence using GRADE. Nine non-randomised studies involving 813 patients were included, with seven studies rated at critical risk of bias. Postoperative complications occurred in 16.0% of uniportal and 30.2% of multiportal patients, with no statistically significant pooled difference (RR 0.49, 95% CI 0.22-1.06; p = 0.069; I²=66%). No significant differences were identified in major complications, conversion, mortality, operative time, blood loss, chest-tube duration, length of stay, or lymph-node yield, or R0 resection. Uniportal surgery was associated with shorter console time (MD - 23.5 min, 95% CI - 35.6 to - 11.4) and lower postoperative day-1 pain (MD - 0.6 points, 95% CI - 0.9 to - 0.3). The 0.5- point pain difference was below commonly used thresholds for clinical importance and lost statistical significance when digitised values were excluded (p = 0.092). Available observational evidence does not demonstrate a clear difference in perioperative safety or surgical quality between uniportal/single-port and multiportal robotic-assisted thoracic surgery. Exploratory subgroup analyses suggested differences in length of stay and operative time by comparator port count, potentially reflecting confounding by operative era and experience. A possible reduction in console time and early postoperative pain was observed, but these findings were based on very-low-certainty evidence and were sensitive to individual studies. **Keywords:** Anatomical pulmonary resection; Meta-analysis; Multiportal robotic-assisted thoracic surgery; Robotic-assisted thoracic surgery; Single-port robotic surgery; Uniportal robotic-assisted thoracic surgery. © 2026. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflicts of interest: The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval: Not required for this systematic review. Consent for publication: Not applicable. Protocol registration: The review protocol was registered in PROSPERO under the registration number: CRD420261432924. ## References 1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 71(3):209–249 2. 1. Siegel RL, Giaquinto AN, Jemal A (2024) Cancer statistics, 2024. Cancer J Clin 74(1):12–49 3. 1. Smythe WR (2001) Treatment of stage I and II non-small-cell lung cancer. Cancer Control 8(4):318–325 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/11483885/) 4. 1. Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, Asamura H (2022) Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 399(10335):1607–1617 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35461558/) 5. 1. Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, Vokes E (2023) Lobar or sublobar resection for peripheral stage IA non–small-cell lung cancer. N Engl J Med 388(6):489–498 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36780674/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10036605/) Show all 55 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Meta-Analysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Meta-Analysis%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Meta-Analysis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Comparative Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Comparative+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Comparative+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) ## MeSH terms * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Length of Stay Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Length+of+Stay%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Length+of+Stay) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Lung* / surgery Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Lung%2Fsurgery%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Lung) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Operative Time Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Operative+Time%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Operative+Time) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Pneumonectomy* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pneumonectomy%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Pneumonectomy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920010/) * Postoperative Complications / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Postoperative+Complications%2Fepidemiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.n
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