Surgery. 2026 Mar 26:110152. doi: 10.1016/j.surg.2026.110152. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aims to rigorously evaluate the early clinical outcomes following implementation of Versius CMR Surgical Robotic System in thoracic surgery and to compare these results with those achieved using a uniportal video-assisted thoracic surgery approach.
METHODS: This study encompassed a cohort of 124 patients who underwent robotic-assisted thoracic surgery, including 92 anatomical lung resections and 32 thymectomies performed by 3 lead surgeons without prior robotic experience. This group was compared with a control group of 229 patients who underwent the same procedures using a uniportal video-assisted thoracic surgery approach in which these 3 surgeons have extensive experience. The study spans the period since implementation of Versius in April 2023 until mid-August 2024 in addition to a group of subxiphoid video-assisted thoracic surgery thymectomies for comparison going back to May 2022. Propensity score-matched analysis was performed to create comparable groups of patients, and patients were matched using the nearest-neighbor matching method without replacement applying a multivariable model including gender, age, smoking, forced expiratory volume in 1 second, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, hypertension, and tumor size. This resulted in a total of 168 matched patients, 84 of which underwent robotic-assisted thoracic surgery matched to 84 patients who underwent uniportal video-assisted thoracic surgery.
RESULTS: The robotic approach showed comparable results to uniportal video-assisted thoracic surgery in terms of complete resection and nodal upstaging. Uniportal video-assisted thoracic surgery showed an advantage in the number of stations on lymph node dissection (P < .001); however, this disappeared following propensity matching. The robotic group required increased conversion rate, which was mostly made electively to ensure safety or facilitate progression. Thirty-day mortality was less than 1% in each group. The average hospital stay in the robotic group was more than 1 day shorter, but with no statistical significance, whereas this stay remained comparable between the matched groups. Operating robotic times demonstrated noticeable improvement in the learning curve following about 7 months and 66 cases.
CONCLUSIONS: Versius robotic surgical system provides smooth adoption and safe implementation in thoracic surgery with satisfactory early clinical results in both thymectomy and anatomical lung resection, even in the lack of prior robotic surgical experience. Extensive experience in alternative approaches is essential to allow for conversion and ensure safe practice.
PMID:41896109 | DOI:10.1016/j.surg.2026.110152
