Abstract
Background and Objective: Complex segmentectomy, defined by the resection of multiple or intricate intersegmental planes, has emerged as a parenchyma-sparing surgical option for early-stage nonsmall cell lung cancer (NSCLC). Its rise has paralleled advancements in minimally invasive techniques, particularly robotic-assisted surgery. This review aims to provide a comprehensive assessment of complex robotic segmentectomy, clarifying definitions, outlining indications and technical considerations, evaluating oncologic outcomes, and exploring its current and future role in lung cancer surgery. Methods: A literature review was conducted using PubMed, Embase, Cochrane Library, and Scopus, focusing on studies published between 2005 and 2025. Eligible studies evaluated outcomes, techniques, and indications for complex segmentectomy, with emphasis on robotic approaches. Key Content and Findings: Evidence demonstrates that complex segmentectomy achieves oncologic outcomes comparable to lobectomy and simple segmentectomy, while preserving lung function and maintaining low complication rates. Preoperative planning with three-dimensional (3D) reconstruction significantly improves surgical precision and reduces postoperative morbidity. Robotic platforms further enhance visualization, dexterity, and technical consistency, facilitating the broader adoption of complex procedures. Conclusions: Complex robotic segmentectomy is a safe, effective, and increasingly important surgical option for early-stage lung cancer. Continued innovation in imaging, technique, and robotic technology will further define and expand its role in thoracic surgery.