Cost in video-assisted thoracic surgery versus robotic-assisted thoracic surgery for lung cancer: should we focus on other metrics?

Historically, pulmonary resections for lung cancer have been done in an open fashion. With the adoption of VATS, incisions became smaller but challenges such as cost, safety, and quality of resection became the center of the discussion. However, now we have extensive evidence of the benefit of minimally invasive approaches. With the introduction of robotic-assisted thoracic surgery (RATS), the discussion has gone back to cost as the main driver. This increased robotic cost has been evaluated by multiple studies without a general consensus, given the varying definitions of cost. Medical institutions and health systems will never share the details of what those technologies cost, which makes comparisons not truly significant. In this article, we analyzed the pros and cons of RATS versus VATS and tried to answer if cost is the adequate metric when comparing both techniques.