Short-term health-related quality of life and pain after total-port robotic versus uniportal video-assisted thoracoscopic anatomical lung resection: a matched prospective cohort study

Background Direct comparisons of patient-reported recovery after total-port robotic-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (VATS) are limited. We compared short-term health-related quality of life (HRQoL) and pain after anatomical lung resection performed with the two approaches. Methods This single-centre prospective observational cohort included consecutive patients undergoing lung surgery from January 2025 to June 2026. The revision analysis was restricted to single lobectomy or segmentectomy. VATS controls were limited to treating teams that used both approaches. RATS and VATS cases were matched 1:1 within resection type and lymph-node management using a propensity model that included treating team, demographic, pulmonary-function and CT tumour variables. HRQoL and pain were assessed preoperatively, on postoperative day (POD) 1, and at 1 and 3 months. Results Thirty-five RATS patients were matched to 35 VATS patients, including 14 lobectomy pairs and 21 segmentectomy pairs. Global HRQoL was not significantly different between groups at baseline (77.4 vs. 81.0), POD 1 (69.3 vs. 71.0), 1 month (86.6 vs. 85.1), or 3 months (84.4 vs. 88.5; all P > 0.05). NRS pain was similar on POD 1 (2.2 vs. 2.2) and at 3 months (0.3 vs. 0.0); at 1 month, RATS had a small nominally higher score (0.9 vs. 0.4, P = 0.018). RATS had longer operative time and greater total drainage, whereas chest-tube duration, complication rates and systematic lymph-node dissection were not significantly different. Conclusions In this small procedure- and nodal-management-matched cohort, the observed short-term HRQoL and pain trajectories were broadly similar. The estimates are imprecise and do not establish equivalence between the surgical approaches. Larger studies comparing the same operations with surgeon-level adjustment are required.