ABSTRACT
The first reports, from Italy and North America, regarding video-assisted thoracoscopic surgery (VATS) lobectomy performed according to modern technical and oncologic principles were published simultaneously. Several papers have now confirmed the validity of VATS lobectomy as a safe, economically and oncologically sound technique. However, the surgeon must use their wisdom and employ an evidence-based approach to recognize its limitations and applicability in all lung resections and all thoracic patients. When VATS lung resections are performed for malignant disease, preoperative surgical staging of the mediastinum with positron emission tomography and endobronchial ultrasound or mediastinoscopy are of paramount importance. A systematic lymph node dissection is performed as part of the operation on either the right or the left side. A combination of blunt and sharp dissection is employed by using an endoscopic suction, high energy devices, or diathermy. Several case-matched analyses have confirmed the superiority of VATS lobectomy to thoracotomy in terms of postoperative morbidity and, occasionally, mortality.
