Striving for 100% minimally invasive reliability

It has been a quarter of a century since the first reported thoracoscopic lobectomy. Over this time, acceptance came gradually but VATS lobectomy now enjoys preference for early stage lung cancer largely because of its reduced complications. This has increased surgery options and associated survivals particularly for frail populations. There has been phased in adoption at most centers, generally starting with patients having smaller, peripheral tumors as described in papers establishing the feasibility of such operations. Accordingly, this has introduced selection bias into large retrospective databases because central and probably more nodal rich tumors were approached by open operations. Similarly, preoperative radiation and chemotherapy which makes dissection more tedious are more likely to yield open approaches or conversions.