Global research trends in robotic-assisted thoracoscopic surgery: a multidimensional analysis from 2000 to 2025.

OBJECTIVE: Robotic-assisted thoracoscopic surgery (RATS) has transformed thoracic surgery, yet fragmented research patterns obscure critical development trajectories and global disparities. METHODS: This study analyzed 3025 RATS publications from 2000 to 2025 using Web of Science Core Collection, Scopus, and PubMed databases. Data visualization and analysis were performed with VOSviewer 1.6.19, CiteSpace 6.2.R3, and the biblioshiny R package. RESULTS: The analysis included 79 countries, 2925 institutions, and 13 408 researchers across 634 journals. Publication trends demonstrate three distinct phases: initial stage (2000-2010), steady growth period (2011-2018), and rapid growth phase (2019-2024). The United States leads with 1061 publications and 22 079 citations. Shanghai Jiao Tong University is the most influential institution (n = 72), while Utrecht University Medical Center demonstrates highest citation efficiency (34.8 citations/publication). The Journal of Thoracic Disease has the most publications (n = 168); Annals of Thoracic Surgery has the most co-citations (6773). Richard Van Hillegersberg is the most prolific author with 39 publications and an H-index of 17, while R.J. Cerfolio has the highest number of co-citations (citations = 506). Current research hotspots include pulmonary resection, esophageal procedures, mediastinal surgery, and implementation optimization. Future research emphasizes AI integration, robotic bronchoscopy, and image-guided navigation. Critical gaps include systematic geographic inequities (2-fold citation disparities), absent cost-effectiveness evidence for diverse health care systems, and undefined training standards. CONCLUSIONS: RATS research exhibits systematic disparities that perpetuate global health inequities. Addressing these gaps requires coordinated international action: affordable platform development, standardized competency frameworks, and context-specific economic validation across diverse health care settings.