[Pulmonary resection using video-assisted thoracoscopic surgery--20 years experience]

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Surgical Oncology

Background:

• Video-assisted thoracoscopic surgery (VATS) has been available for two decades but faces slow adoption due to debated efficacy and varied techniques.
• Past concerns included suboptimal outcomes and a lack of clear benefits compared to conventional open surgery.

Purpose of the Study:

• To define accepted VATS resection techniques.
• To review VATS outcomes, including morbidity and mortality, in comparison to open thoracotomy.
• To discuss VATS in the context of evolving medical treatments and technologies.

Main Methods:

• Review of existing literature and definitions of VATS.
• Comparison of short-term and long-term outcomes (survival, morbidity, mortality) between VATS and thoracotomy.
• Analysis of recent technological improvements impacting VATS.

Main Results:

• VATS has not demonstrated superior survival rates compared to thoracotomy based on level-one evidence.
• A modest advantage for VATS has been observed in short-term outcomes.
• Technological advancements have enhanced VATS efficacy, particularly for small lung lesions detected via CT screening.

Conclusions:

• VATS represents an evolution, not a revolution, in thoracic surgery.
• VATS offers advantages in specific scenarios like treating small lung lesions and facilitates surgical education.
• VATS should be considered alongside other treatments like stereotactic radiotherapy and radiofrequency ablation.