Minimally Invasive Resection for Lung Cancer

Surgery is the standard of care for early stage lung cancer. The traditional surgical approach for lung resection is through a posterolateral thoracotomy; this involves transecting muscles and retracting the ribs. This results in significant postoperative pain and compromised cough effort leading to high pulmonary morbidity. Researchers have been looking for alternatives to reduce trauma of access to thoracic cavity. Video-assisted thoracoscopic surgery (VATS) offers this alternative. While thoracoscopy dates back to 1910, it was after 1990, when modern telescopes, high definition camera, dedicated instruments, energy sources, and endoscopic staplers became available that complex thoracoscopic procedures were performed. First VATS lobectomy was reported in 1991; since then, more and more centers across the globe have adopted the technique for lung resection. The technique has been shown to reduce postoperative pain, pulmonary complications, hospital stay, and improved quality of life without compromising the oncological outcomes. Over the years, the technique of thoracoscopic surgery has evolved: from conventional “multi-port” approach to “uniportal” and “needle-scopic” approach. Also, complexity of surgery has increased: from simple lobectomy to bronchial and vascular sleeve resections. Advances in technology is improving the ease of performing VATS: introduction of telescope with three-dimensional vision, camera, and monitors with high resolution images. Introduction of robotic-assisted thoracoscopic surgery (RATS) has introduced a new dimension to minimal invasive thoracic surgery. Despite all the advances, it is imperative that the art of conventional thoracic surgery is imparted to all trainees as it will continue to be the backbone of lung surgery for years to come.