Uniportal VATS for anatomical lung resection: 15 years of innovation

The evolution of thoracic surgery has progressively moved toward minimizing surgical trauma while preserving oncological radicality in the treatment of lung cancer. Within this context, uniportal video-assisted thoracoscopic surgery (VATS) has emerged as one of the most significant innovations in minimally invasive thoracic surgery. In fact, uniportal VATS not only represents the evolution of multiportal VATS, with the potential to reduce postoperative pain, chest wall trauma, and recovery time, but has also led to a paradigm shift in thoracic surgery, redefining the limits of minimally invasive pulmonary resection. Initially developed for minor thoracic procedures, the first milestone in its evolution occurred in 2011 with the report of the first uniportal lobectomy. Since then, uniportal VATS technique has rapidly spread and has become an established minimally invasive approach for lung cancer treatment in many centers worldwide. Progressively, this technique has expanded from lobectomy to segmentectomy and from standard anatomical resections to highly complex bronchovascular reconstructions. After 15 years of innovation, uniportal VATS has profoundly transformed the surgical management of lung cancer and continues to redefine the boundaries of minimally invasive thoracic oncology, influencing the evolution of uniportal robotic platforms. This narrative review aims to describe the historical, technical, and conceptual evolution of uniportal VATS for anatomical lung resection over the years, highlighting the milestones that contributed to its global dissemination and current role in thoracic surgical oncology.