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Among 160 consecutive patients, complex procedures show higher major morbidity, reintervention, and longer hospital stays, while mortality and overall morbidity remain 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Surgery 2025, 40(12), ivaf294 ORIGINAL ARTICLE  \n[https://doi.org/10.1093/icvts/ivaf294](https://doi.org/10.1093/icvts/ivaf294) Advance Access publication 4 December 2025  \nCite this article as: Colmenares O, Gmez-Hernndez MT, Rivas CE, Fuentes MG, Manama M, Gmez F et al. Preoperative Factors Associated with Surgical Complexity and Postoperative Outcomes in Patients Undergoing Robotic Anatomical Segmentectomy. Interdiscip CardioVasc Thorac Surg 2025; doi:10.1093/ icvts/ivaf294.  \nPreoperative Factors Associated with Surgical Complexity and Postoperative Outcomes in Patients Undergoing Robotic  \nAnatomical Segmentectomy  \nOscar Colmenares1,2; M. Teresa Gmez-Hernndez 􀀃 ,1,2,3; Cristina E. Rivas 1,2,3; Marta G. Fuentes 1,2,3;  \nMario Manama 1,2; Francisco Gmez 1; Carmen Taboada1; Clara Forcada 1,2,3; Mara Caro1;  \nMarcelo F. Jimnez1,2,3  \n1Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, 37007, Spain 2Salamanca Institute of Biomedical Research, Salamanca, 37007, Spain  \n3University of Salamanca, Salamanca, 37007, Spain  \n􀀃 Corresponding author. Service of Thoracic Surgery, Salamanca University Hospital, 37007 Salamanca, Spain ([mtgomezh@saludcastillayleon.es](mtgomezh@saludcastillayleon.es)). Received: August 8, 2025; Revised: October 15, 2025; Accepted: November 24, 2025  \nGraphical abstract  \nMeeting presentation: The abstract of this manuscript was presented as a poster at the 33rd Annual Meeting of the European Society of Thoracic Surgeons (ESTS), held in Budapest, Hungary, from May 25-27, 2025.  \nTHORACIC ONCOLOGY  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.  \n2 Interdisciplinary CardioVascular and Thoracic Surgery, 2025, Volume 40, Issue 12 Abstract  \nObjectives: Anatomical segmentectomy is increasingly used for early-stage lung cancer due to its parenchymal-sparing benefits. However, it remains technically challenging, and procedural complexity is often inconsistently defined. Robotic-assisted surgery, offering enhanced dexterity and visualization, has become more widespread but still requires high technical expertise. This study aimed to identify preoperative factors associated with procedural complexity and evaluate its impact on postoperative outcomes.  \nMethods: This single-centre cohort study included 160 consecutive patients who underwent robotic segmentectomy by 2 expert surgeons between November 2018 and August 2025. Complex procedures were defined as those with operative time >125 min (75th percentile), conversion to another surgical approach, or changes in the planned resection due to intraoperative technical challenges. Logistic regression was used to identify preoperative variables associated with complexity. Postoperative outcomes were compared between complex and non-complex cases.  \nResults: Thirty-seven segmentectomies (23. 1%) were classified as complex. Predictors of complexity included age (odds ratio [OR] ¼ 1.042, P ¼ .063), transverse pleural diameter (OR ¼ 0.716, P ¼ .089), and number of staple planes (OR ¼ 1.644, P ¼ .058), while the presence of emphysema (OR ¼ 0.428, P ¼ .076) appeared to be protective. Mortality, overall morbidity, prolonged air leak, and readmission rates were similar between groups. However, complex cases had significantly higher rates of major morbidity (13.5% vs 1.6%, P ¼ .008), reintervention (10.8% vs 0.8%, P ¼ .010), and longer hospital stays (median 3 vs 2 days, P ¼ .004).  \nConclusions: This exploratory analysis identified preoperative factors associated with procedural complexity in robotic segmentectom","cbCain9doweR3p5q","https://ap.wps.com/l/cbCain9doweR3p5q","pdf",927996,"English","# Objectives\n# Methods\n# Results\n# Conclusions\n# Introduction\n## Indications and trends in anatomical segmentectomy\n## Technical demands and robotic approach\n## Inconsistent definitions of complexity","[{\"question\":\"What is the purpose of this study on robotic anatomical segmentectomy?\",\"answer\":\"The study aims to identify preoperative factors associated with procedural complexity and assess how complexity influences postoperative outcomes.\"},{\"question\":\"How does the study define a “complex” procedure?\",\"answer\":\"Procedures are classified as complex if operative time exceeds 125 minutes, there is conversion to another approach, or intraoperative technical challenges lead to changes in the planned resection.\"},{\"question\":\"Which preoperative factors were associated with higher procedural complexity?\",\"answer\":\"Predictors include age, transverse pleural diameter-related measures, and the number of staple planes, while the presence of emphysema appeared protective in the analysis.\"}]","Preoperative Factors Associated with Surgical Complexity and Postoperative Outcomes in Patients Undergoing Robotic Anatomical Segmentectomy | PDF",1790755252,18]