Video-assisted Thoracoscopic Surgery Experience Research Articles

Outcomes of robot-assisted versus video-assisted mediastinal mass resection during the initial learning curve

To compare the learning curve of mediastinal mass resection between robot-assisted surgery and thoracoscopic surgery. Retrospective perioperative data were collected from 160 mediastinal mass resection cases. Data included 80 initial consecutive video-assisted thoracoscopic surgery (VATS) resection cases performed from February 2018 to February 2020 and 80 initial consecutive robotic-assisted thoracic surgery (RATS) resection cases performed from March 2020 to March 2023. All cases were operated on by a thoracic surgeon. The clinical characteristics and perioperative outcomes of the two groups were compared. The operation time in both the RATS group and VATS group was analyzed using the cumulative sum (CUSUM) method. Based on this method, the learning curves of both groups were divided into a learning period and mastery period. The VATS group and the RATS group crossed the inflection point in the 27th and 21st case, respectively. Subsequently, we found that the learning period was longer than the mastery period with statistically significant differences in terms of the operating time, and postoperative hospital stay in the VATS group and the RATS group. A certain amount of VATS experience can shorten the learning curve for RATS.

Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children.

Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial. The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis. Retrospective single-center cohort study. A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information. There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493). The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.

Could video-assisted thoracoscopic surgery be feasible for blunt trauma patients with massive haemothorax?

IntroductionThe study reviewed the experience of video-assisted thoracoscopic surgery (VATS) for the treatment of massive haemothorax (MHT). Materials and MethodsAll adult patients who sustained blunt trauma with a diagnosis of traumatic haemothorax or pneumothorax (ICD9 860; ICD10 S27.0–2), injury to the heart and lungs (ICD9 861; ICD10 S26, S27.3–9), and injury to the blood vessels of the thorax (ICD9 901; ICD10 S25) were queried from the trauma registry between 2014 and 2018. Patients who had chest tube drainage amounts meeting the criteria for MHT and who underwent subsequent operations were eligible for analyses. The patients were divided into VATS or thoracotomy groups based on the surgical modalities. Descriptions and analyses of the two groups were made. ResultsThirty-eight patients were enroled in the study, including 8 females (21%) and 30 males. The median age was 47.0 (first quartile (Q1) 25.5 and third quartile (Q3) 59.3) years. Twenty-three patients were in the VATS group, six (26%) of whom were converted to thoracotomy. There were no obvious differences in age, sex, pulse rate, or systolic pressure on arrival to the ED or after resuscitation between the two groups. The laboratory data were worse amongst the thoracotomy group, especially the arterial blood gas analysis (ABG) results: pH 7.2 (7.1, 7.3) vs. 7.4 (7.2, 7.4); HCO3 14.6 (12.4, 18.7) vs. 19.7 (16.1, 23.9) mEq/L; base excess (BE) -12.6 (-15.8, -7.8) vs. -5.2 (-11.1, -0.9) mEq/L. The PaO2/FiO2 ratio was lower in the thoracotomy group (91.4 (68.5, 193.3) vs. 245.3 (95.7, 398.0) mmHg). The thoracotomy group had coagulopathy (INR 1.6 (1.2, 1.9) vs. 1.3 (1.1, 1.4)) and required more blood transfusions (WB and PRBC 36.0 (16.0, 48.0) vs. 12.0 (4.0, 24.0) units; FFP 20.0 (6.0, 50.0) vs. 6.0 (2.0, 20.0) unit). No factors associated with VATS conversion to thoracotomy could be identified. ConclusionsVATS could be applied to selected blunt trauma patients with MHT. The major differences between the VATS and thoracotomy groups were coagulopathy, acidosis, PaO2/FiO2 ratio < 200 mmHg, or a persistent need for blood transfusion.

Assessing VATS competence based on simulated lobectomies of all five lung lobes.

To determine the number of procedures and expert raters necessary to provide a reliable assessment of competence in Video-Assisted Thoracoscopic Surgery (VATS) lobectomy. Three randomly selected VATS lobectomies were performed on a virtual reality simulator by participants with varying experience in VATS. Video recordings of the procedures were independently rated by three blinded VATS experts using a modified VATS lobectomy assessment tool (VATSAT). The unitary framework of validity was used to describe validity evidence, and generalizability theory was used to explore the reliability of different assessment options. Forty-one participants (22 novices, 10 intermediates, and 9 experienced) performed a total of 123 lobectomies. Internal consistency reliability, inter-rater reliability, and test-retest reliability were 0.94, 0.85, and 0.90, respectively. Generalizability theory found that a minimum of two procedures and four raters or three procedures and three raters were needed to ensure the overall reliability of 0.8. ANOVA showed significant differences in test scores between the three groups (P < 0.001). A pass/fail level of 19 out of 25 points was established using the contrasting groups' standard setting method, leaving one false positive (one novice passed) and zero false negatives (all experienced passed). We demonstrated validity evidence for a VR simulator test with different lung lobes, and a credible pass/fail level was identified. Our results can be used to implement a standardized mastery learning training program for trainees in VATS lobectomies that ensures that everyone reaches basic competency before performing supervised operations on patients.

Simulation-based VATS resection of the five lung lobes: a technical skills test.

Video-Assisted Thoracoscopic Surgery (VATS) lobectomy is an advanced procedure and to maximize patient safety it is important to ensure the competency of thoracic surgeons before performing the procedure. The objective of this study was to investigate validity evidence for a virtual reality simulator-based test including multiple lobes of the lungs. VATS experts from the department of Cardiothoracic Surgery at Rigshospitalet, Copenhagen, Denmark, worked with Surgical Science (Gothenburg, Sweden) to develop VATS lobectomy modules for the LapSim® virtual reality simulator covering all five lobes of the lungs. Participants with varying experience in VATS were recruited and classified as either novice, intermediate, or experienced surgeons. Each participant performed VATS lobectomy on the simulator for three different randomly chosen lobes. Nine predefined simulator metrics were automatically recorded on the simulator. Twenty-two novice, ten intermediate, and nine experienced surgeons performed the test resulting in a total of 123 lobectomies. Analysis of Variances (ANOVA) found significant differences between the three groups for parameters: blood loss (p < 0.001), procedure time (p < 0.001), and total instrument path length (p = 0.03). These three metrics demonstrated high internal consistency and significant test-retest reliability was found between each of them. Relevant pass/fail levels were established for each of the three metrics, 541ml, 30min, and 71m, respectively. This study provides validity evidence for a simulator-based test of VATS lobectomy competence including multiple lobes of the lungs. The test can be used to ensure basic competence at the end of a simulation-based training program for thoracic surgery trainees.

Initial experience with uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer performed by a surgeon who did not have previous experience performing multiportal thoracoscopic surgery: a single center retrospective study.

BackgroundThe purpose of this study was to evaluate the surgical outcome of uniportal video-assisted thoracoscopic surgery (VATS) for the treatment of non-small cell lung cancer performed by a surgeon who did not have previous experience performing open thoracotomy and multiportal VATS.MethodsFrom January 2017 to December 2018, 85 patients underwent uniportal VATS anatomical pulmonary resection performed by one surgeon. The remaining 269 patients underwent multiportal VATS performed by other experienced surgeons. Clinicopathological characteristics and surgical outcomes of the uniportal VATS and multiportal VATS groups were compared.ResultsThe uniportal VATS procedures included 7 segmentectomies, 66 lobectomies, 1 bilobectomy, and 1 pneumonectomy. There was no conversion to multiportal VATS or open thoracotomy. Patients who underwent multiportal VATS surgery were older, more often men, and more often smokers than those who underwent uniportal VATS. Other clinicopathological characteristics were not statistically different between the two groups. The number of dissected lymph nodes was higher in uniportal VATS than in multiportal VATS (16.8 vs. 14.6, P=0.030). Anesthetic time and operative time were shorter in uniportal VATS than in multiportal VATS (both P<0.001). Intraoperative blood loss was also less in the uniportal VATS group than in the multiportal VATS group (P<0.001). There were no statistical between-group differences in chest tube drainage period, hospital stay, postoperative complication rate, and operative mortality rate.ConclusionsUniportal VATS for pulmonary anatomical resection of non-small cell lung cancer performed by a surgeon without previous multiportal VATS experience yielded acceptable surgical outcomes.

Defining the learning curve of robotic thoracic surgery: what does it take?

Controversy exists as to what constitutes a learning curve to achieve competency, and how the initial learning period of robotic thoracic surgery should be approached. We conducted a systematic review of the literature published prior to December 2018 using PubMed/MEDLINE for studies of surgeons adopting the robotic approach for anatomic lung resection or thymectomy. Changes in operating room time and outcomes based on number of cases performed, type of procedure, and existing proficiency with video-assisted thoracoscopic surgery (VATS) were examined. Twelve observational studies were analyzed, including nine studies on robotic lung resection and three studies on thymectomy. All studies showed a reduction in operative time withan increasing number of cases performed. A steep learning curve was described for thymectomy, with a decrease in operating room time in the first 15 cases and a plateau after 15-20 cases. For anatomic lung resection, the number of cases to achieve a plateau in operative time ranged between 15-20 cases and 40-60 cases. All but two studies had at least some VATS experience. Six studies reported on experience of over one hundred cases and showed continued gradual improvements in operating room time. The learning curve for robotic thoracic surgery appears to be rapid with most studies indicating the steepest improvement in operating time occurring in the initial 15-20 cases for thymectomy and 20-40 cases for anatomic lung resection. Existing data can guide a standardized robotic curriculum for rapid adaptation, and aid credentialing and quality monitoring for robotic thoracic surgery programs.

VATS versus open thoracic surgery in Brazil—where are we standing?

Video-assisted thoracoscopic surgery (VATS) technique for anatomical lung resections have been available for more than two decades. It’s been proved to be a safe technique with lower complications rate and comparable survival outcomes for lung cancer when compared to traditional open thoracotomy. However, this minimally invasive approach is not worldwide widely used. This perspective reviews Brazilian VATS experience.

Uniportal video-assisted thoracoscopic surgery for the treatment of thoracic emergencies.

While video-assisted thoracoscopic surgery (VATS) is well accepted in the management of thoracic emergencies, uniportal VATS has not yet been studied for this indication. This paper reports the results of the treatment of chest trauma patients by uniportal VATS in a single center with extensive experience in uniportal VATS. In this prospective study all patients who underwent uniportal VATS for thoracic surgical emergency cases, between 06/2012 and 09/2017, were included and the data were reviewed retrospectively. Six hundred forty-two uniportal VATS procedures were performed. Among those, 12 emergency cases could be identified. The indication was a hemothorax with active bleeding in all cases and the uniportal VATS approach was carried out after carefully evaluating all clinical factors and risks related to such a special setting. The location, extent and severity of the injuries were diagnosed and treated intraoperatively. The conversion rate was zero. The mean surgical time was 106.25 minutes [63-240], the chest tube was removed after 6.75 days in average (range, 1-25). All patients were transferred to the post anesthesia care unit (PACU) or intensive care unit (ICU) for at least one night (range, 1-25). The mean postoperative hospital stay was 10.67 days [4-26]. In expert hands, uniportal VATS approach seems to be a safe and feasible procedure for both, the diagnostics and management of emergency cases, such as active thoracic bleeding in cardiopulmonary stable patients.

PC03.05 Debate on Standard Surgical Approaches - Open Thymectomy

PC03.05 Debate on Standard Surgical Approaches - Open Thymectomy

Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy-results from 120 consecutive patients.

Uniportal video-assisted thoracoscopic surgery (VATS) is considered a technically demanding procedure. The learning curve, which directly influences the adoption of uniportal VATS, has not been described. In this study, we aimed to describe the learning curve for uniportal VATS lobectomy from our single center's experience. Uniportal VATS lobectomy was started in October 2013 in Zhongshan Hospital, Fudan University. Since then, a total of 120 consecutive patients who underwent uniportal VATS lobectomy were retrospectively enrolled. Surgical videos were reviewed to determine the operation time, to which cumulative sum (CUMSUM) method was applied to evaluate the learning phases of the procedure. Accordingly, patients' clinical features in different phases were collected and compared to determine the learning curve for uniportal VATS lobectomy. Among the 120 consecutive patients reviewed from October 2013 to September 2014, the CUMSUM curve showed its inflection at patient number 44: the first 30 patients were in the ascending phase, the second 30 patients were in the plateau phase, and the remaining patients were in the descending phase. Comparable CUMSUM results were recorded both from upper and not-upper lobectomy. Intra-operatively, more repeated stapler attempts (73% versus 13% and 5%, P<0.001) and higher conversion rate (17% versus 7% and 2%, P=0.028) were recorded in ascending phase vs. the plateau phase and descending phase, respectively. Post-operatively, the morbidity, mortality and the length of hospital stay were similar before and after the learning curve cases. In a center with conventional VATS experience, the learning period of uniportal VATS lobectomy was characterized by repeated stapler attempts, and the volume requirements would be approximately 30 cases to reach the performance plateau. Upper lobectomy seemed not more difficult to learn than lower or middle lobectomy in uniportal VATS.

Staged bronchial closure in uniportal video-assisted thoracoscopic anatomical resection for lung cancer with calcified lymph nodes.

Uniportal video-assisted thoracoscopic surgery (VATS) makes a breakthrough in these years. Even we have gained more experience and surgical skills of uniportal VATS, some elements, such as calcified perivascular lymph nodes, make the surgery challenging. In this series, we used staged bronchial closure (cut the bronchus first and then close it with stapler after dividing the pulmonary artery with calcified lymph node) as an approach for dealing with this challenging issue. Though the rate of intraoperative vessel injury is relatively high, we obtained ideal surgical outcome by using this technique in different lobes and segment of the lung.

Right sided VATS thymectomy: “current standards of extended thymectomy for myasthenia gravis”

Video-assisted thoracoscopic surgery (VATS) is a major component of minimally invasive technics with increasing number as a consequences of advancements in modern technology. VATS thymectomy is also became a feasible and safe surgery in high-volume VATS experience centers. Right sided videothoracoscopic approach for thymectomy that we perform is explained in this review article.

Safety and feasibility of uniportal video-assisted thoracoscopic surgery for locally advanced non-small cell lung cancer.

Conventional video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced non-small cell lung cancer (NSCLC) is a feasible and safe surgery in high-volume centers with significant VATS experience. Uniportal VATS lobectomy has been recently been reported to be a promising, less invasive approach. The purpose of this study is to explore the safety and feasibility of uniportal video-assisted thoracoscopic surgery (U-VATS) for the treatment of patients with locally advanced NSCLC. From January 2013 to September 2015, a total of 132 patients with locally advanced NSCLC underwent U-VATS or open thoracotomy major pulmonary resections and standard mediastinal lymph node dissection. Patients were divided into two groups: (I) locally advanced NSCLC underwent U-VATS (U-VATS); (II) locally advanced NSCLC underwent open thoracotomy (open). A descriptive and retrospective study was performed, including the operative time, operative blood loss, postoperative chest tube duration, postoperative hospital stay, lymph node dissection, postoperative complications and postoperative recovery. A total of 132 patients with locally advanced NSCLC were included in this study: 64 (U-VATS) vs. 68 (open) patients. The patient demographic data was similar in both groups. Median operative time (157.0 vs. 160.6) and median number of lymph nodes (35.5 vs. 32.5) were similar in both groups. Chest tube duration and hospital of stay were statistically shorter in U-VATS group while rate of complications were higher in open thoracotomy group. One patient died on the 55th postoperative day because of tumor metastasis and bronchopleural fistula. A higher percentage of patients who underwent UVATS resections were able to receive adjuvant therapy timely compared to the open group. Uniportal VATS major pulmonary resections and mediastinal lymph node dissection is a safe and feasible procedure for the treatment of locally advanced NSCLC. Particularly it is suitable for the frail patients with locally advanced NSCLC who require comprehensive treatment.

Video-Assisted Thoracic Surgery Resection and Reconstruction of Carina and Trachea for Malignant or Benign Disease in 12 Patients: Three Centers’ Experience in China

Although video-assisted thoracoscopic surgery (VATS) has been widely applied to both peripheral and central lung cancer treatment in many centers, there is great hesitation to adopt it for carinal or tracheal surgical procedures. The aims of this study were to explore the feasibility of VATS in the treatment of benign and malignant diseases involving the carina and trachea and to highlight relevant techniques. Patients undergoing VATS carinal or tracheal procedures between May 2012 and July 2015 from three centers in China were included in this study. Their clinical characteristics, operative details, and postoperative course were analyzed. Twelve patients underwent five different types of VATS airway reconstructions with or without lobectomy: including right bronchial resection with partial carinal reconstruction (3 patients), tracheal resection and reconstruction (4 patients), tracheal or right bronchial resection with carinal reconstruction (3 patients), left bronchial resection with carinal reconstruction (1 patient), and right pneumonectomy with carinal reconstruction (1patient). Complete resection was achieved in all patients. The mean operative time was 224 ± 78 minutes, and the median time of the first anastomosis was 41 minutes (range, 15 to 60 minutes), regardless of whether the reconstruction was a tracheal or carinal. The median estimated blood loss was 100 mL (range 10 to 1000 mL). The mean postoperative hospital stay was 12.5 ± 2.5 days. There was no perioperative mortality or major morbidity. Median duration of follow-up was 12 months (range 5 to 43 months). VATS resection and reconstruction of the carina or trachea are feasible, and these procedures can be safely performed using the techniques described. We believe, with the accumulation of VATS experience, these procedures could be adopted as routine approaches in tracheal surgery.

Video-assisted thoracoscopic treatment of primary spontaneous pneumothorax in older children and adolescents.

Primary spontaneous pneumothorax (PSP) is a relatively rare condition in the pediatric population lacking of specific recommendations regarding the management. Video-assisted thoracoscopic surgery (VATS) has gained widespread consensus during the last 10 years. We retrospectively reviewed our experience of VATS in the treatment of pediatric patients affected by PSP in terms of timing of surgery, operative technique, and postoperative outcome. Between 1998 and 2014, 58 pediatric patients were treated for PSP. Treatment consisted in pulmonary apicectomy in all patients and pleurodesis. Patients received either apical pleurectomy and mechanical pleurodesis or mechanical pleurodesis alone. Mean age was 16.6 ± 1.6 years (range 10-18) with a male/female ratio of 5:1. Seventeen patients underwent surgery after the first episode of PSP. Apical pleurectomy and mechanical pleurodesis was performed in 30 patients while others received mechanical pleurodesis alone. Conversion to open surgery was needed in four procedures (6.9%). Postoperative complications occurred in 1.7% of cases. Sixteen patients received more than one procedure for contralateral pneumothorax (15 cases) and postoperative recurrence (1 case). The mean follow-up was 95 ± 63 months. Recurrence rate was 12.1%. Univariate analysis showed that recurrence was significantly correlated with younger age (P = 0.044) and postoperative chest tube (P = 0.027). Both univariate and multivariate analysis showed that apical pleurectomy did not prevent recurrences. VATS is an effective procedure for PSP in pediatric patients. Apical pleurectomy does not seem to prevent recurrence. Due to the increased risk of recurrence of PSP in younger patients, indication to VATS after the first episode might be considered. Pediatr Pulmonol. 2016;51:713-716. © 2016 Wiley Periodicals, Inc.

Techniques and difficulties dealing with hilar and interlobar benign lymphadenopathy in uniportal VATS.

Surgical treatment of lung cancer has evolved to a minimally invasive approach and currently is recognized as an acceptable treatment for resectable non-small cell lung cancer (NSCLC). As the volume and complexity of cases has increased technical difficulties had arisen. Hilar and sublobar lymph nodes can represent a challenge for video-assisted thoracoscopic surgery (VATS) surgeons in order to complete a safe dissection of vascular and bronchial structures without complications or conversion. It is not unusual the patients with smoking history or benign infections in the past present with enlarged calcified nodes that are fused to the hilum, fissure and specially the bronchus which can lead to an accident during the procedure if the surgeon has no experience handling this issue. As the amount of surgeons carrying out VATS lobectomies grows it is very important for them to know what to do in this specific case so the completion of the procedure can be achieved safely. The coordination between the surgeon and the assistant is very important in order to carry out the procedure without discomfort positions and good visualization, the use of energy devices in expert hands can help considerably during the dissection of lymph nodes in the hilum and fissure reducing the bleeding, which provides a clean operative field. It is a necessary maneuver during the dissection to find the correct adventitial plane between the lymph node and the structure before passing it. The videos in this article show the different maneuvers a VATS surgeon can implement when facing enlarged fussed lymph nodes in the hilum, fissure or mediastinum. Improving exposure, opening the fissure, using energy and carrying out the dissection through the correct plane are keys to complete the procedure successfully. With growing experience in uniportal VATS and advances in surgical technology, enlarged or fussed lymph nodes are no longer a contraindication to complete a VATS lobectomy, experience VATS surgeons have a repertory of options in order to perform a safe and effective dissection.

Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?

IntroductionThe 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%).MethodsOverall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure.ResultsThere was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01).ConclusionsA comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

Single-Incision Thoracoscopic Right Upper Lobectomy with Chest Wall Resection by Posterior Approach

Lobectomy requiring chest wall resection is usually performed by thoracotomy, but thanks to the advances in the field of thoracoscopic surgery, this procedure can be performed by video-assisted thoracoscopic surgery (VATS). Recent improvements in surgical devices and previous VATS experience have allowed this complex surgery for advanced stages to be undertaken safely. Most of the thoracoscopic lobectomies with rib resection are performed using three to four incisions. We report a different minimally invasive technique for chest wall resection (minimally invasive posterior approach) and VATS right upper lobectomy (single-incision anterior approach).

Surgeons’ Volume-Outcome Relationship for Lobectomies and Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques

This study examined the effect of surgeons' volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.