Complex Thoracic Resections in the Minimally Invasive Era: Is Open Surgery Becoming a Lost Skill?

Area of Science:

• Thoracic Surgery
• Surgical Education
• Minimally Invasive Surgery

Background:

• Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) have become prevalent, offering patient benefits.
• Minimally invasive techniques now dominate anatomical pulmonary resections in many centers.
• This shift raises concerns about declining trainee exposure to open thoracotomy.

Purpose of the Study:

• To examine the impact of minimally invasive surgery on open thoracic surgical competence.
• To identify scenarios where open surgery remains essential.
• To discuss implications for surgical training and competence preservation.

Main Methods:

• Narrative review of current minimally invasive thoracic surgery practices.
• Analysis of clinical scenarios necessitating open thoracotomy.
• Consideration of training implications and regional practice variations.

Main Results:

• Open surgery remains indispensable for complex procedures like bronchoplastic/angioplastic resections and managing hostile fields or conversions.
• Declining exposure to open surgery poses a risk to developing comprehensive surgical skills.
• Variability in thoracic surgical practice exists across different regions.

Conclusions:

• Open thoracic surgery is a foundational competence, not obsolete.
• Preservation of open surgical skills requires structured training, simulation, mentorship, and assessment.
• The decline in open surgical exposure is a credible, foreseeable risk to surgical competence.