Efficacy of Da Vinci robot-assisted thoracoscopic surgery combined with three-dimensional imaging for precisive segmentectomy in stage IA non-small cell lung cancer ≤2 cm: a retrospective cohort study

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Background: With the increasing use of low-dose computed tomography (LDCT), the detection rate of early-stage non-small cell lung cancer (NSCLC) with tumors ≤2 cm has significantly risen. While lobectomy remains the standard treatment, it may compromise postoperative pulmonary function. Segmentectomy offers a function-preserving alternative, yet poses greater technical challenges. This study aimed to evaluate the safety and efficacy of robot-assisted thoracoscopic surgery (RATS) combined with three-dimensional imaging technology for precise anatomical segmentectomy in patients with stage IA NSCLC ≤2 cm. Methods: This retrospective study included 184 patients with stage IA NSCLC (T1a-1bN0M0) treated between October 2021 and October 2024. Patients were divided into two groups: Group A (video-assisted thoracoscopic segmentectomy, n=96) and Group B (RATS with three-dimensional imaging, n=88). Perioperative outcomes, postoperative complications, and pulmonary function at 6 months were compared. Results: Although Group B had a longer operative time (P<0.05), it showed significant advantages in the number and stations of lymph nodes dissected, shorter chest tube duration and hospital stay (P<0.05). Although the incidence of prolonged air leak (>5 days) was not statistically significant between the two groups, group B showed a lower incidence. At 6 months postoperatively, Group B had significantly better preserved pulmonary function [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF); P<0.05]. Conclusions: Robot-assisted segmentectomy guided by three-dimensional imaging is safe and feasible for patients with stage IA NSCLC. Compared with conventional video-assisted thoracoscopic surgery, this technique offers superior preservation of pulmonary function and a lower incidence of postoperative air leakage, highlighting its potential for broader clinical application.

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