# Robotic-assisted versus open resection of pulmonary sequestration: a retrospective cohort study. RATS surgery for pulmonary sequestration

## TL;DR

This study compares robotic-assisted and open surgery for removing a rare lung condition called pulmonary sequestration, finding that robotic surgery offers shorter hospital stays and fewer complications.

## Contribution

The study provides clinical evidence that robotic-assisted surgery is a viable alternative to traditional open surgery for pulmonary sequestration.

## Key findings

- RATS surgery resulted in shorter hospital stays and earlier chest tube removal compared to open surgery.
- Despite longer operative times, RATS showed a trend toward fewer postoperative complications.
- RATS is a safe and effective minimally invasive option for pulmonary sequestration resection.

## Abstract

Pulmonary sequestration (PS) is a rare congenital lung malformation often requiring surgical resection due to recurrent infections or hemoptysis. Traditionally treated via open thoracotomy, recent advancements have made minimal-invasive approaches like robotic-assisted thoracoscopic surgery (RATS) increasingly viable. This study compares outcomes between RATS and open resection for PS in a high-volume center.

In this retrospective cohort study, 23 adult patients who underwent surgical resection of PS between 2010 and 2023 were analyzed. Fifteen patients were treated via open thoracotomy (THKT), while eight underwent RATS using the DaVinci-X system. We compared preoperative findings, intraoperative variables, and postoperative outcomes.

The patients in the RATS group were younger (median age: 36 vs 47 years) and had a shorter median hospital stay (5 vs 10 days, p < 0.001) compared to the THKT group. The RATS group also experienced earlier chest drainage removal (3 vs. 4 days, p = 0.016). However, the median duration of surgery was longer for RATS (118 vs. 75 min, p = 0.018). A trend towards less postoperative complications was observed in the RATS group (33% vs. 0%).

RATS provides a safe and effective alternative to open surgery for PS resection, with benefits including reduced hospital stay and earlier chest tube removal. Despite longer operative times, the minimally invasive approach may offer enhanced recovery and fewer complications. Continued accumulation of experience with RATS is likely to improve operative efficiency, making it a valuable option in the surgical management of pulmonary malformations.

The online version contains supplementary material available at 10.1007/s11748-025-02172-9.