Robotic is better than VATS? Ten good reasons to prefer robotic versus manual VATS surgery in lung cancer patients

Different variants of minimally invasive lung resection have been described during the last decades including uniportal, non-intubated video-assisted thoracoscopic surgery (VATS), as well as, more recently, the subxiphoid VATS lobectomy. Robot-assisted thoracic surgery (RATS) is a relatively recent evolution of manual videoendoscopic surgery, born with the idea to make minimally invasive techniques an option even for complex procedures with the help of computer and micromechanics. Thus, after a period to gain confidence with the new system, robotic surgery found a great consensus among surgeons. With its development and diffusion in many surgical disciplines, including thoracic surgery, studies on its efficacy, safety and feasibility compared to conventional techniques have been performed. This has produced a healthy competition between VATS and RATS, even if these studies gave controversial results in terms of perioperative outcome and complications. A definitive conclusion is not available about a real benefit for the patients in the field of lung cancer treatment. Despite that, many aspects of robotic surgical platforms foreshadow that robotic systems will become an essential reality in the surgeon’s armamentarium of the future. We expose the main features of robotic surgery to demonstrate that RATS is better than VATS to treat lung cancer patients.