BACKGROUND: The detection of pulmonary nodules is increasing every year, as well as the need for surgical treatment in more patients, which places a significant burden on surgeons. Surgeon fatigue not only increases surgical risk, but also poses a health hazard to the surgeons. How to reduce surgeon fatigue is an important issue that needs to be addressed urgently. METHODS: We collected 917 patients who underwent thoracoscopic surgery between 2022 and 2023. They were categorized into thoracoscopy group, mechanical arm group and pneumatic arm group according to the procedure. Data related to the perioperative period (operative time, blood loss, serious adverse events, etc.) of different patients were retrospectively analyzed. The related scale of fatigue index was also designed to quantify and analyze the fatigue index of doctors. RESULTS: There were 316, 302 and 299 patients in the thoracoscopic, mechanical and pneumatic arm groups, respectively. There was no statistically significant difference in operative time, bleeding, mean length of hospital stay, and serious adverse events among the three groups. Although there was no significant difference in overall surgical fatigue scores among the three groups, the use of robotic and pneumatic arms significantly reduced the fatigue of surgeons and assistants in complicated surgeries. CONCLUSION: Compared to traditional thoracoscopic surgery, the application of surgical assistance robotic arm does not increase perioperative risk. Moreover, in longer thoracoscopic procedures, it significantly reduces fatigue for both the surgeons and their assistants. However, current robotic arms still have certain limitations and require continuous improvements to better meet clinical demands.