The evolution of robotic-assisted thoracic surgery: current platforms, emerging technologies, and future perspectives - a narrative review

Abstract

Abstract Robotic-assisted thoracic surgery (RATS) has undergone rapid technological evolution over the past two decades, progressively expanding from early minimally invasive applications to increasingly complex thoracic procedures. This narrative review examines the historical development of robotic platforms in thoracic surgery, the emergence of new approaches and alternative robotic systems, and future technological perspectives. A literature search was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and the Cochrane Library to identify relevant English-language publications through May 2026. Early robotic systems established the feasibility of robotic thoracic procedures, particularly mediastinal surgery and selected pulmonary resections, while also defining the technical limitations that shaped early practice, including demanding docking, arm-collision issues, dependence on bedside assistance, and lack of console-controlled stapling. The da Vinci Xi refined multiport robotic surgery through improved arm design, overhead boom architecture, simplified docking, and integrated stapling, supporting greater standardization and broader adoption of robotic thoracic surgery. In parallel, reduced-port approaches, including biportal and uniportal RATS, emerged through technical adaptation of existing platforms. The da Vinci SP introduced a dedicated single-port architecture, whereas the da Vinci 5 represents a further step toward haptic feedback and data-driven robotic surgery. Emerging systems such as Versius, Hugo RAS, Toumai, and Shurui SP reflect a diversifying robotic landscape, with modular, portable, and lower-cost design, that may influence future access and adoption. Future developments include artificial intelligence, augmented reality, digital twins, autonomous assistance, and remote surgery. Overall, robotic thoracic surgery is evolving from a purely mechanical platform toward a more integrated digital surgical environment, although the clinical impact, accessibility, training requirements, and long-term benefits of many emerging technologies remain to be fully established.