Robotic vs. uniportal lobectomy: a prospective analysis of postoperative pain, analgesic requirements, and individual risk factors

Abstract

Introduction: Lung carcinoma represents a malignancy with the highest global mortality rate. Surgical treatment remains the cornerstone of curative therapy, with minimally invasive techniques currently dominating the field. This study aimed to compare post­operative pain in patients undergoing lobectomy for lung cancer via uniportal video-assisted thoracoscopic surgery (UVATS) vs. robotic-assisted thoracic surgery (RATS).

Methods: This prospective study included 140 patients (70 RATS, 70 UVATS) undergoing lobectomy with mediastinal lymphadenectomy. Patients assessed their pain using the Short-Form McGill Pain Questionnaire and visual analogue scale (VAS) on the 3^rd and 14^th postoperative days. We also analyzed the influence of age, gender, and BMI on pain perception and analgesic requirements.

Results: Patients following RATS exhibited significantly higher pain intensity compared to UVATS on both the 3^rd (VAS 5.8 ± 2.0 vs. 3.8 ± 1.6; P < 0.00001) and 14^th postoperative days (VAS 2.7 ± 1.1 vs. 2.2 ± 1.1; P = 0.00133). Combined analgesic therapy was more frequently required in the RATS group. Female patients demonstrated markedly higher pain intensity and analgesic requirements in both surgical approaches. Age and BMI had no significant impact on pain perception.

Conclusion: Robotic-assisted surgery is associated with higher postoperative pain compared to uniportal video-assisted thoracoscopy, with differences being more pronounced in female patients. We recommend implementing targeted analgesic strategies for robotic procedures and considering the use of 8-mm ports instead of standard 12-mm ports to reduce chest wall trauma.

doi: 10.48095/ccrvch2025533