Single-port robotic thoracic surgery: a systematic review and meta-analysis of comparative outcomes versus multiport robotic surgery and uniportal VATS

Single-port robotic-assisted thoracic surgery (SP-RATS) has expanded rapidly, but its comparative effectiveness remains uncertain across platforms and access strategies. We systematically evaluated SP-RATS against multiport robotic-assisted thoracic surgery (MP-RATS) and uniportal video-assisted thoracoscopic surgery (uVATS). PubMed/MEDLINE, CENTRAL, Scopus, ClinicalTrials.gov, and supplementary sources were searched through October 5, 2026. Random-effects meta-analyses with modified Knapp-Hartung inference were used for continuous and common binary outcomes, whereas rare events were analyzed using fixed-effect Peto odds ratios. Risk of bias was assessed using ROBINS-I and the Joanna Briggs Institute checklist, and certainty using GRADE. Sixty reports were included; 23 provided Group A or B comparative data, with one study at critical risk of bias excluded from the primary quantitative synthesis. Compared with MP-RATS, SP-RATS demonstrated broadly similar perioperative outcomes without a consistent disadvantage. Lymph-node yield was nominally lower (MD, − 1.18 nodes; 95% CI, − 2.31 to − 0.05; P = 0.043), but this finding did not persist across sensitivity analyses. Compared with uVATS, SP-RATS was associated with shorter chest-tube duration (MD, − 0.49 days; 95% CI, − 0.85 to − 0.13; P = 0.013), with additional favorable signals in lymph-node yield, chest drainage, and conversion, although these were less consistent across sensitivity analyses. Complications, R0 resection, and mortality did not differ significantly between approaches. Certainty of evidence was low or very low across all pooled outcomes. SP-RATS appears to be a viable minimally invasive alternative, achieving reduced robotic access without an evident trade-off in perioperative safety or immediate oncologic outcomes. Prospective comparative studies are needed to determine whether reduced robotic access provides reproducible clinical benefit.