Minimally invasive pulmonary surgery for lung cancer, up to date


Recently, the minimally invasive surgical approach is an important issue in the pulmonary surgery. In this review, we present the current fashion of video-assisted thoracic surgery (VATS) and new approach including robotic lobectomy. There is no clear definition or standard for this surgical procedure regarding VATS lobectomy. Therefore, no randomized controlled trial of VATS and conventional lobectomy can be set up. Although the definition of VATS lobectomy is not straightforward, VATS lobectomy showed the technical feasibility of conventional lobectomy in mortality and postoperative complication as well as lymph node dissection. VATS procedure for advanced lung cancer is unclear whether such observations can be developed into a standardized approach. There are no reports to evaluate the advantages of robotic lobectomy in terms of treatment outcomes for lung cancer compared with VATS lobectomy. However, we believe that robotic lobectomy has clear potential to improve the quality of minimally invasive surgery.

This is a preview of subscription content, log in to check access.


  1. 1.

    Swanson SJ, Herndon JE 2nd, D’Amico TA, Demmy TL, McKenna RJ Jr, Green MR, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802—A Prospective, Multi-Institution Feasibility Study. J Clin Oncol. 2007;25:4993–7.

    PubMed  Article  Google Scholar 

  2. 2.

    Okada M, Sakamoto T, Yuki T, Mimura T, Miyoshi K, Tsubota N. Hybrid surgical approach of video-assisted minithoracotomy for lung cancer significance of direct visualization on quality of surgery. Chest. 2005;128(4):2696–701.

    PubMed  Article  Google Scholar 

  3. 3.

    Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg. 2012;60(5):255–60.

    PubMed  Article  Google Scholar 

  4. 4.

    McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81(2):421–5.

    PubMed  Article  Google Scholar 

  5. 5.

    Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH Jr, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244(3):420–5.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139(2):366–78.

    PubMed  Article  Google Scholar 

  7. 7.

    Hartwig MG, D’Amico TA. Thoracoscopic lobectomy: the gold standard for early-stage lung cancer? Ann Thorac Surg. 2010;89(6):S2098–101.

    PubMed  Article  Google Scholar 

  8. 8.

    Villamizar NR, Darrabie MD, Burfeind WR, Petersen RP, Onaitis MW, Toloza E, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009;138(2):419–25.

    PubMed  Article  Google Scholar 

  9. 9.

    Cao C, Manganas C, Ang SC, Yan TD. A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy. Ann Cardiothorac Surg. 2012;1(1):16–23.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Flores RM, Park BJ, Dycoco J, Aronova A, Hirth Y, Rizk NP, et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009;138:11–8.

    Article  PubMed  Google Scholar 

  11. 11.

    Kondo T, Sagawa M, Tanita T, Sato M, Ono S, Matsumura Y, et al. Is complete systematic nodal dissection by thoracoscopic surgery possible? A prospective trial of video-assisted lobectomy for cancer of the right lung. J Thorac Cardiovasc Surg. 1998;116(4):651–2.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 2000;24(1):27–30.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Watanabe A, Mishina T, Ohori S, Koyanagi T, Nakashima S, Mawatari T, et al. Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur J Cardiothorac Surg. 2008;33(5):812–8.

    PubMed  Article  Google Scholar 

  14. 14.

    Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139(4):976–81.

    PubMed  Article  Google Scholar 

  15. 15.

    Denlinger CE, Fernandez F, Meyers BF, Pratt W, Zoole JB, Patterson GA, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg. 2010;89(6):1730–6.

    PubMed  Article  Google Scholar 

  16. 16.

    D’Amico TA, Niland J, Mamet R, Zornosa C, Dexter EU, Onaitis MW. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg. 2011;92(1):226–31.

    PubMed  Article  Google Scholar 

  17. 17.

    Boffa DJ, Kosinski AS, Paul S, Mitchell JD, Onaitis M. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg. 2012;94(2):347–53.

    PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Hennon M, Sahai RK, Yendamuri S, Tan W, Demmy TL, Nwogu C. Safety of thoracoscopic lobectomy in locally advanced lung cancer. Ann Surg Oncol. 2011;18(13):3732–6.

    PubMed  Article  Google Scholar 

  19. 19.

    Craig SR, Walker WS. Initial experience of video assisted thoracoscopic pneumonectomy. Thorax. 1995;50(4):392–5.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Conlan AA, Sandor A. Total thoracoscopic pneumonectomy: indications and technical considerations. J Thorac Cardiovasc Surg. 2003;126(6):2083–5.

    PubMed  Article  Google Scholar 

  21. 21.

    Nwogu CE, Glinianski M, Demmy TL. Minimally invasive pneumonectomy. Ann Thorac Surg. 2006;82(1):e3–4.

    PubMed  Article  Google Scholar 

  22. 22.

    Sahai RK, Nwogu CE, Yendamuri S, Tan W, Wilding GE, Demmy TL. Is thoracoscopic pneumonectomy safe? Ann Thorac Surg. 2009;88(4):1086–92.

    PubMed  Article  Google Scholar 

  23. 23.

    Gonzalez-Rivas D, de la Torre M, Fernandez R, Garcia J. Video: single-incision video-assisted thoracoscopic right pneumonectomy. Surg Endosc. 2012;26(7):2078–9.

    PubMed  Article  Google Scholar 

  24. 24.

    Nwogu CE, Yendamuri S, Demmy TL. Does thoracoscopic pneumonectomy for lung cancer affect survival? Ann Thorac Surg. 2010;89(6):S2102–6.

    PubMed  Article  Google Scholar 

  25. 25.

    Demmy TL, Nwogu CE, Yendamuri S. Thoracoscopic chest wall resection: what is its role? Ann Thorac Surg. 2010;89(6):S2142–5.

    PubMed  Article  Google Scholar 

  26. 26.

    Suda T, Kitamura Y, Hasegawa S, Negi K, Hattori Y. Video-assisted thoracoscopic extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2007;134(4):1088–9.

    PubMed  Article  Google Scholar 

  27. 27.

    Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132(4):769–75.

    PubMed  Article  Google Scholar 

  28. 28.

    Okada M. Radical sublobar resection for lung cancer. Gen Thorac Cardiovasc Surg. 2008;56(4):151–7.

    PubMed  Article  Google Scholar 

  29. 29.

    D’Amico TA. Thoracoscopic segmentectomy: technical considerations and outcomes. Ann Thorac Surg. 2008;85:S716–8.

    PubMed  Article  Google Scholar 

  30. 30.

    Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg. 2012;94(2):668–81.

    PubMed  Article  Google Scholar 

  31. 31.

    Zhong C, Fang W, Mao T, Yao F, Chen W, Hu D. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer. Ann Thorac Surg. 2012;94(2):362–7.

    PubMed  Article  Google Scholar 

  32. 32.

    Iwata H, Shirahashi K, Mizuno Y, Matsui M, Takemura H. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg. 2013 Jan 11 [Epub ahead of print].

  33. 33.

    Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya K, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg. 2011;141(3):678–82.

    PubMed  Article  Google Scholar 

  34. 34.

    Okada M, Mimura T, Ikegaki J, Katoh H, Itoh H, Tsubota N. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg. 2007;133(3):753–8.

    PubMed  Article  Google Scholar 

  35. 35.

    Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg. 2012;1(1):24–6.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc. 2002;16(10):1389–402.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: current status and prospects. Gen Thorac Cardiovasc Surg. 2013;61(3):127–32.

    PubMed  Article  Google Scholar 

  38. 38.

    Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg. 2006;131(1):54–9.

    PubMed  Article  Google Scholar 

  39. 39.

    Cao C, Manganas C, Ang SC, Yan TD. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg. 2012;1(1):3–10.

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Pardolesi A, Park B, Petrella F, Borri A, Gasparri R, Veronesi G. Robotic anatomic segmentectomy of the lung: technical aspects and initial results. Ann Thorac Surg. 2012;94(3):929–34.

    PubMed  Article  Google Scholar 

  41. 41.

    Nakamura H, Taniguchi Y, Miwa K, Fujioka S, Matsuoka Y, Kubouchi Y. A successful case of robotic bronchoplastic lobectomy for lung cancer. Ann Thorac Cardiovasc Surg. 2012 Nov 30 [Epub ahead of print].

  42. 42.

    Park BJ, Melfi F, Mussi A, et al. Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg. 2012;143:383–9.

    PubMed  Article  Google Scholar 

  43. 43.

    Gonzalez-Rivas D. VATS lobectomy: surgical evolution from conventional VATS to uniportal approach. Sci World J. 2012;2012. doi:10.1100/2012/780842.

    Article  Google Scholar 

  44. 44.

    Oda M, Matsumoto I, Waseda R, Watanabe G. Total port-access lobectomy via a subcostal trans-diaphragmatic approach for lung cancer. Interact Cardiovasc Thorac Surg. 2013;16(2):211–3.

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Hisashi Iwata.

Additional information

The review was submitted at the invitation of the editorial committee.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Iwata, H. Minimally invasive pulmonary surgery for lung cancer, up to date. Gen Thorac Cardiovasc Surg 61, 449–454 (2013).

Download citation


  • VATS
  • Robotic surgery
  • Minimally invasive surgery