Abstract

Over the last 25 years, improvement in instrumentation and surgical techniques has led to widespread adaptation of thoracoscopic (VATS) surgery in the field of thoracic oncology. What once was a niche operation like VATS wedge resection to now hybrid VATS chest wall resections, and advanced surgeries like bronchoplasty and sleeve resections are done with VATS. This has led to improved surgical outcomes for our patients and increased use of surgery in the treatment of chest disease. We review the history of VATS and its current state with most recent changes and upgrades in the technique in this chapter. We review the advancement in uniportal VATS, robotic assisted resection, complex VATS resection, and awake lung surgery with VATS.

Highlights

  • Attributed in large part to fiber optics for light transmission, enhanced image processing and rendering, and the advent of the surgical staplers, interest in VATS was piqued

  • 83.2% were performed for non-small cell lung cancer (NSCLC) with an overall conversion rate of 1.6% (8 of 500)

  • The incidence of postoperative complications, including atrial fibrillation, atelectasis, prolonged air leak, transfusion requirements, pneumonia, renal failure death, and shorter hospital stay, were all found to be less common in the VATS lobectomy group

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Summary

History of thoracoscopy

While the modern era of thoracoscopy begins in the early 1990s and includes Giancarlo Roviaro’s report of the first thoracoscopic lobectomy as a major milestone [1], the term thoracoscopy dates back to a procedure performed by Francis Richard Cruise and Samuel Gordon in 1865 [2]. In 1882, coincidentally the year Robert Koch discovered Mycobacterium tuberculosis [3], Carlo Forlanini observed that spontaneous pneumothorax could collapse cavitary lesions and lead to their resolution [4] From this observation, he introduced a procedure of inducing artificial closed pneumothoraces by inserting a needle in the anterior axillary line and forcing air into the pleural space, the first minimally invasive thoracic procedure. Robotic assisted thoracic surgery (RATS) can serve a role in thoracic surgery, for mediastinal procedures Each of these different techniques has the potential to serve an important role as part of the thoracic surgeon’s armamentarium [6]

VATS lobectomy
Long-term outcomes of VATS lobectomy for NSCLC
Development of single port VATS
Development of robotic-assisted VATS
Development of awake VATS
Findings
10. Conclusion
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