Background: At present, research comparing robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in lobectomy/segmentectomy for lung cancer is insufficient. This paper aimed to compare the safety, short-term efficacy, quality of life (QoL), and delayed complications at 6 weeks postoperatively via a retrospectively controlled study by a single surgeon.Methods: A total of 110 non-small cell lung cancer (NSCLC) cases from December 2020 to May 2021 were enrolled in this retrospective study, and were divided into RATS and VATS groups (both three-port procedures) according to the patients' preference. The propensity-score matching method was applied to control the potential differences. The patients were treated with lobectomy/segmentectomy for lung cancer by RATS or VATS, and the safety outcomes were evaluated. The follow-up was initiated after surgery, and the outcome assessments including hospitalization costs, short-term efficacy, pain and QoL, were collected and analyzed.Results: Both matched groups achieved a R0 resection rate of 100%. The average operation time of the RATS group was 21 minutes shorter than VATS (P<0.01), and the average hospitalization costs of the RATS group was 17,746 China Yuan higher than VATS (P<0.01). Furthermore, the visual analogue pain scores of the RATS group were lower than those of the VATS group at 1 day and 6 weeks postoperatively (2.53±0.86 vs. 3.88±0.88 and 0.35±0.65 vs. 0.74±0.88, respectively, P<0.05). Moreover, the core QoL scale score for cancer patients in the RATS group were higher than those of the VATS group at 6 weeks postoperatively (98.64±5.73 vs. 93.02±15.21, respectively, P<0.05). No significant differences were observed in the other indicators.Conclusions: Despite its high cost, RATS showed considerable potential for reducing the operation time and improving the QoL of patients. Meanwhile, RATS and VATS exhibited similar perioperative safety and short-term efficacy in lobectomy and segmentectomy.

Background Situs inversus totalis (SIT) is a relatively rare congenital abnormality in which the major thoracic and abdominal visceral organs are reversed from their usual positions. In patients with SIT and bronchial carcinoma, surgical difficulty increases sharply. It has been reported that the video-assisted thoracic surgery (VATS) still poses the operator to a challenge situation. The similarity of surgical positions and the flexibility of the mechanical arm in robotic surgery, may be beneficial to SIT patients due to reducing technical difficulties. Here, we present a first case of SIT patient with lung cancer, in which Da Vinci robot-assisted thoracic surgery (RATS) was performed successfully. Case presentation A 66-year old patient, previously diagnosed with SIT since childhood, came to our hospital with two pulmonary nodules in his left lung field. The bigger one had increased somewhat for the last 2 years of follow-up. Software Mimics was preoperatively carried out to analyze anatomical variations. RATS was conducted to complete left upper lobectomy and left middle wedge resection. The patient had no intraoperative complications and was discharged day 5 after the operation. Conclusions This is the first report of a successful robot-assisted lung cancer resection in a patient with SIT. In such challenging cases as lung cancer and rare anomaly as SIT, RATS is more advantageous and suitable than VATS with the help of software Mimics utilized for 3D reconstruction, which can identify the anatomical abnormalities and facilitate the surgical procedures.