Robotic-assisted tracheobronchoplasty for excessive central airway collapse: a systematic review of clinical outcomes, safety, and functional recovery.

Excessive central airway collapse (ECAC), encompassing tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC), is increasingly recognized as a debilitating condition with substantial symptomatic and functional burden. Robotic-assisted tracheobronchoplasty (R-TBP) has emerged as a minimally invasive alternative to open repair; however, its collective clinical outcomes have not been systematically synthesized. We conducted a systematic review of comparative and non-comparative studies reporting outcomes of R-TBP, following PRISMA guidelines (PROSPERO: CRD420251241127). A systematic search of PubMed, Scopus, Cochrane, and Web of Science was performed through August 14, 2025. Outcomes included postoperative pulmonary function, functional exercise capacity (6MWT), patient-reported outcome measures (PROMs), perioperative parameters, and complications. Due to substantial heterogeneity in outcome definitions, follow-up intervals, and reporting standards, a quantitative meta-analysis was precluded, and a narrative synthesis was performed. Risk of bias was assessed using ROBINS-I. Four studies comprising 231 patients were included. Operative duration ranged from 264 to 504 min. Postoperative recovery was rapid, characterized by minimal ICU utilization (0 to 1.33 days) and a median hospital length of stay of 2.33 to 5 days markedly shorter than historical open benchmarks. Clinical efficacy was most pronounced in patient-reported outcomes: studies consistently reported substantial quality-of-life improvements, including SGRQ reductions of 11.6 to 36.7 points. Functional capacity also showed improvement, with 6MWT distance increases ranging from 10.3 to 76.3 m. Conversely, pulmonary function outcomes were heterogeneous; while some cohorts showed modest gains in predicted FEV1 (+ 1.7% to + 8%), others demonstrated stabilization rather than significant improvement. Safety profiles were acceptable, with major complications (Clavien-Dindo ≥ IIIa) ranging from 14% to 21%. R-TBP represents a technically demanding yet increasingly viable alternative to open surgery. The available data consistently demonstrates clear benefits regarding postoperative recovery and patient-reported quality of life, suggesting that symptomatic relief outweighs the inconsistent spirometric improvements often seen in this population. Current evidence positions R-TBP as a safe approach with superior immediate recovery metrics compared to historical open standards. While the certainty of evidence is limited by retrospective designs, the consistency of the safety signal supports R-TBP's role in the surgical armamentarium. Future comparative trials should prioritize patient-reported outcomes and functional measures like the 6MWT over static spirometry to accurately gauge efficacy.