Video-Assisted Thoracic Surgery Approaches in Lung Cancer Management

Video-assisted thoracic surgery (VATS) encompasses a suite of minimally invasive techniques for resecting lung tumours with the aim of reducing surgical trauma, postoperative pain and hospital stay compared with open thoracotomy. Since its introduction in the early 1990s, VATS has evolved from multiport access to uniportal approaches and has been complemented by advances in instrumentation and anaesthetic management. Standard resections include lobectomy, segmentectomy and mediastinal lymphadenectomy, each performed through small thoracic incisions under endoscopic visualisation. The uniportal technique consolidates all instruments and camera in a single intercostal incision, promising reduced intercostal nerve irritation and enhanced cosmetic outcomes. Integration with neoadjuvant immunochemotherapy has extended indications in locally advanced lung cancer, while comparisons with robot-assisted thoracic surgery (RATS) continue to refine selection criteria. Globally, centres report high rates of complete resection and favourable long-term survival, although variability in learning curves, instrumentation cost and perioperative risk stratification remain challenges. Current research seeks to optimise patient selection, enhance lymph node sampling and develop predictive tools for postoperative complications, reinforcing VATS as a cornerstone of modern lung cancer management.

Research from Nature Portfolio

A recent propensity-matched study compared uniportal VATS lobectomy with multiport VATS in patients undergoing intentional resection for non-small cell lung cancer over a five-year interval. After matching for baseline characteristics, both groups demonstrated similar intraoperative blood loss, conversion rates to open thoracotomy and numbers of harvested lymph nodes and stations. Postoperative drainage time, hospital length of stay, morbidity, mortality and long-term overall and disease-free survival were equivalent. These findings support the safety and efficacy of a single-incision approach as an alternative to traditional multiport VATS without compromising oncological outcomes.

Video-Assisted Thoracic Surgery Approaches in Lung Cancer Management publication trend

The graph below shows the total number of articles in video-assisted thoracic surgery approaches in lung cancer management across all publications each year (not limited to Nature Index journals).

Technical terms

Video-assisted thoracoscopic surgery (VATS): A minimally invasive technique in which a camera and instruments are introduced through small thoracic incisions to perform lung resections.

Uniportal VATS: A VATS approach employing a single intercostal incision for camera and instrument access to reduce nerve trauma.

Lobectomy: Surgical removal of an entire lobe of the lung, commonly performed to treat localized lung cancer.

Neoadjuvant immunochemotherapy: Combined chemotherapy and immunotherapy administered prior to surgery to shrink tumours and address micrometastases.

Propensity score matching: A statistical method that balances baseline characteristics between treatment groups in observational studies to reduce selection bias.

Nomogram: A graphical predictive model that integrates multiple variables to estimate the probability of a clinical event.

Delayed extubation: The decision to remove the endotracheal tube outside the operating theatre due to concerns over immediate postoperative respiratory stability.

References

1. Short-term outcomes of robot-assisted versus video-assisted thoracoscopic surgery for non-small cell lung cancer patients with neoadjuvant immunochemotherapy: a single-center retrospective study. Frontiers in Immunology (2023).
2. A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery. Annals of Medicine (2023).
3. Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis. Cancers (2023).
4. Long-term outcome of uniport vs. multiport video-assisted thoracoscopic lobectomy for lung cancer. Scientific Reports (2024).