The evolution of vats and minimally invasive techniques in the treatment of lung cancer: a narrative review

Abstract

Background and Objective: Video-assisted thoracoscopic surgery (VATS) has undergone rapid evolution and has become standard practice in recent decades. Understanding how VATS developed from open approaches can help shed light on how minimally invasive surgical techniques will continue to evolve in the future. This narrative review serves to provide readers with a synopsis of the origins of minimally invasive thoracic surgery; the rapid adoption of minimally invasive surgery (MIS); and the outcomes of these new techniques, as compared to one another and conventional thoracotomy. Methods: A review of past literature on PubMed and Google Scholar was conducted using MeSH terms and key words, respectively, between November 2022 to July 2023. Selected articles were written in English and either focused on the evolution of minimally invasive techniques for lung resection or compared post-operative outcomes and prognosis between techniques. The reference lists of retrieved articles were also explored, and additional papers were included by expert reviewer suggestion to add to the depth of the paper. Key Content and Findings: Since the advent of VATS, the thoracic subspecialty has seen many new minimally invasive techniques including robotic assisted thoracic surgery (RATS), subxiphoid excisions, and uniportal approaches. There is sufficient evidence to suggest VATS is favourable to thoracotomy in terms of perioperative and postoperative outcomes while maintaining similar 5-year survival rates. There is evidence that RATS is either equivalent or superior to VATS in regard to perioperative outcomes while possibly conferring a shorter learning curve. Uniportal intercostal and subxiphoid incisions may reduce postoperative pain when compared to multiportal VATS, but further research is warranted. Conclusions: The evolution of VATS begins with the conception of the early endoscope and does not seem to have an end in sight. It is clear that these MIS approaches offer advantages to conventional thoracotomy; however, there is conflicting evidence regarding how they compare to one another. This narrative review suggests further randomized trials and meta-analyses are required to confirm which minimally invasive approach is most favourable in the resection of lung cancer.