The Evolution of VATS Lobectomy

Abstract

Video-Assisted Thoracic Surgery (VATS) has without doubt been the most significant advance in thoracic surgery over the past half century. No other single innovation has so totally revolutionized the way thoracic surgeons perform their craft, or so greatly improved the surgical experience for patients undergoing thoracic operations worldwide. In any surgical specialty, patients in the 21st Century are already well aware of the benefits of minimally invasive surgery. Thoracic surgery is no exception. Throughout the world, patients requiring major lung resection surgery are increasingly demanding that they receive VATS. The trend for ever increasing proportions of lung resections being performed with a VATS approach is inexorable. This is true around the globe, from Asia to Europe to North America. It is becoming ever more difficult for thoracic surgeons to justify not using a VATS in the face of overwhelming evidence for the benefits of this approach – not only in terms of reducing patient morbidity, but also in improving surgical outcomes. Yet behind the hype and glamour of VATS today, there are aspects of the approach that even many experienced thoracic surgeons tend to overlook. It is often forgotten that VATS was first used for major lung resection two decades ago. During its infancy, VATS lobectomy was often dismissed as a gimmick or a fad with only limited niche applicability in thoracic surgery as a whole. The story of how VATS lobectomy matured, developed and evolved over the past 20 years to become the mainstream approach it is today contains many lessons for the modern thoracic surgeon. These include: realizing the importance of accurately defining a minimally invasive surgical approach such as VATS; establishing reliable outcome measures to objectively validate its efficacy; and continuing efforts to improving its outcomes and affirm its role in modern clinical practice. This chapter aims to provide an overview of how VATS lobectomy has evolved over the past two decades from a minor novelty into a fundamental pillar of thoracic surgical practice. The many innovations made and insights gained during the maturation of the VATS approach have had profound influence on how thoracic surgery as a whole is practiced today.