Impact of modern minimally invasive approaches on pulmonary resection outcomes: a narrative review

Anatomic pulmonary resection remains the gold standard for resectable non-small cell lung cancer (NSCLC). This review evaluates the evolution, intraoperative outcomes, clinical efficiency, oncological adequacy, and cost-effectiveness of minimally invasive thoracic surgery (MITS) relative to traditional open thoracotomy.

A systematic literature search was conducted in PubMed, Cochrane Library, and Wiley Library for studies published through early 2026, prioritizing randomized controlled trials (RCTs) and large-scale registry analyses comparing video-assisted thoracoscopic surgery (VATS), robotic-assisted thoracic surgery (RVATS), and open thoracotomy.

MITS (comprising VATS and RVATS) is associated with significantly lower perioperative mortality, reduced postoperative pain, shorter hospital stays, and fewer complications compared to open thoracotomy. While intraoperative conversion remains a risk, robotic platforms exhibit lower conversion rates than VATS in several large series. Oncologically, all three modalities provide equivalent nodal upstaging and disease-free survival (DFS), provided oncological principles are rigorously maintained. While robotic surgery incurs higher procedural costs, these are partially mitigated by reduced postoperative resource utilization.

MITS has become the standard of care for early-stage NSCLC. Recent data suggest that robotic platforms may offer advantages in technical precision and lower conversion rates, although VATS remains a highly cost-effective and efficacious approach. Future innovations in single-port robotics continue to advance the reduction of surgical trauma.