Current Status, Clinical Outcomes and Socioeconomic Challenges of Uniportal Video-Assisted Thoracoscopic Surgery in Japan Compared with Robot-Assisted Thoracic Surgery: A Narrative Review

Multiportal video-assisted thoracoscopic surgery (VATS) was introduced in Japan in the 1990s, with uniportal VATS (U-VATS) and robot-assisted thoracic surgery (RATS) following in the 2010s. U-VATS gained significant traction after the 1st Fellowship of the Japanese Association for Chest Surgery (JACS; currently the Japanese Society for Thoracic Surgery, JSTS) in 2018, leading to the establishment of the Japanese Uniportal VATS Interest Group (JUVIG) in April 2018. JUVIG has since driven wider adoption through extensive activities, including educational programs, publications, and collaborative multicenter studies. As a result, expert surgeons now utilize U-VATS for complex procedures such as bronchoplasty, completion lobectomy, complex segmentectomy, and pediatric surgery. Concurrently, RATS gained insurance coverage in Japan in 2018 and has become more prevalent than U-VATS. Despite the significant costs associated with RATS, its adoption rate surpasses that of U-VATS due to institutional policies, perceived ease of implementation, branding, recruitment incentives, and recent national healthcare insurance reimbursement revisions (add-ons) introduced in 2026, which may create administrative pressure to prioritize robotic cases. Although reduced-port RATS is gaining popularity—blurring the lines with U-VATS—and newly emerging indigenous robotic platforms are expected to further accelerate RATS adoption, multiportal VATS (M-VATS) remains the dominant approach in many institutions. Furthermore, maintaining proficiency in VATS, U-VATS, and open thoracotomy remains indispensable for surgical education, economic viability, and acute intraoperative crisis management. Ultimately, while U-VATS represents a promising minimally invasive option, its widespread adoption for major and complex resections in Japan continues to be restricted by both educational and societal barriers.