Thoracotomy, video-assisted thoracoscopic surgery and robotic video-assisted thoracoscopic surgery: does literature provide an argument for any approach?

Over the past two decades, video-assisted thoracoscopic surgery (VATS) has emerged as a safe and feasible alternative approach to conventional open thoracotomy in the treatment of non-small cell lung cancer (NSCLC). More recently, robotic VATS (RVATS) has gained increased interest as another minimally invasive option for selected patients. The objective of this review was to examine the current literature to compare the short- and long-term clinical outcomes of VATS and RVATS with open thoracotomy. Endpoints included long-term survival, perioperative complications, length of stay, operating time, cost of procedure and quality of life. From our review, we found that VATS offer similar, if not superior, long-term survival outcomes as the traditional thoracotomy approach for selected patients with NSCLC. Perioperative complication rates and length of hospitalization appear to be lower in minimally invasive (VATS and RVATS) approaches when compared with thoracotomy. Similarly, patients reported improved quality of life outcomes after minimally invasive surgery. Operative times were longest in the RVATS groups, but cost analyses were less robust. Although the ideal approach for an individual patient is dependent on the complexity of the patient’s disease, the surgeon’s experience, and the available instrumentation, the current trend towards minimally invasive approaches appears justified according to best available evidence.