Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Overview of minimally invasive thoracic surgery

Todd Demmy, MD
Elisabeth Dexter, MD
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Video-assisted thoracoscopic surgery (VATS) is a set of minimally invasive thoracic surgical (MITS) procedures used to diagnose or treat conditions of the chest (pulmonary, mediastinal, chest wall). Most major procedures traditionally performed with open thoracotomy can be performed using smaller incisions with video assistance. A related technology, robotic-assisted thoracic surgery (RATS), uses computers to aid surgeon instrument control. The essential difference between VATS and RATS is that with VATS, the surgeon holds the instruments, whereas with RATS, the surgeon controls the instruments from the console but does not directly handle the instruments. In this topic review, we will use the broader term MITS to include VATS and RATS, using individual terms when specifically needed.

MITS provides safe, effective, and successful surgery when patients are selected appropriately. The indications have expanded as technology has improved. Continued outcome assessments are needed to ensure that MITS provides equivalent or improved outcomes compared with traditional open surgical methods. Quality of life assessments, morbidity rates, and recovery timelines also are important factors for comparison. Although few trials exist, many observational studies indicate that MITS has less perioperative morbidity and equivalent oncologic results compared with open operations. For special populations, such as frail and older adult patients, outcomes may be better. Generally, perioperative costs for minimally invasive procedures (both VATS and RATS) are higher because of the equipment used. However, overall costs may be lower due to faster patient recovery.

The diagnostic and therapeutic uses of MITS, including an overview of the indications, the preoperative evaluation, procedures, perioperative care, and surgical outcomes, are reviewed here.


In the same manner in which laparoscopic techniques reduce the need for large abdominal incisions, minimally invasive thoracic surgery (MITS) eliminates the need for thoracotomy that requires spreading of the ribs (figure 1) or sternotomy incisions (figure 2). (See "Abdominal access techniques used in laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery".)

MITS uses a thoracoscope attached to a video camera to see into the chest. The lens and the instruments necessary to perform the surgery are inserted between the ribs and into the chest cavity through one or multiple small incisions. The basic principles used in open thoracic surgery (exposure, traction, countertraction) govern MITS as well, but the surgeon's hands remain outside of the chest cavity (or, in the case of robotic surgery, at a separate console), to manipulate and work the end of the instruments, which are located inside the chest.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Thu Jan 26 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Bravo Iñiguez CE, Armstrong KW, Cooper Z, et al. Thirty-Day Mortality After Lobectomy in Elderly Patients Eligible for Lung Cancer Screening. Ann Thorac Surg 2016; 101:541.
  2. Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg 2012; 256:487.
  3. Fernandez FG, Kosinski AS, Burfeind W, et al. The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes. Ann Thorac Surg 2016; 102:370.
  4. Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009; 138:419.
  5. Paul S, Altorki NK, Sheng S, 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; 139:366.
  6. Agzarian J, Fahim C, Shargall Y, et al. The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review. Semin Thorac Cardiovasc Surg 2016; 28:182.
  7. Yang CF, Sun Z, Speicher PJ, et al. Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base. Ann Thorac Surg 2016; 101:1037.
  8. Blasberg JD, Seder CW, Leverson G, et al. Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: Current Practice Patterns and Predictors of Adoption. Ann Thorac Surg 2016; 102:1854.
  9. Louie BE, Wilson JL, Kim S, et al. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg 2016; 102:917.
  10. https://www.abts.org/root/home/certification/operative-requirements.aspx (Accessed on July 29, 2016).
  11. Chu D, Vaporciyan AA, Iannettoni MD, et al. Are There Gaps in Current Thoracic Surgery Residency Training Programs? Ann Thorac Surg 2016; 101:2350.
  12. Yan TD, Cao C, D'Amico TA, et al. Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg 2014; 45:633.
  13. Brezler M, Abeles H. Differentiation between hydropneumothorax and destroyed lung by thoracoscopy with a fiberoptic bronchoscope. Chest 1975; 68:267.
  14. GORECKI Z. Thoracoscopy as a diagnostic procedure in pulmonary tuberculosis. Can Med Assoc J 1953; 69:415.
  15. Yim AP. The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis. Chest 1996; 110:829.
  16. Boushy SF, North LB, Helgason AH. Thoracoscopy: technique and results in eighteen patients with pleural effusion. Chest 1978; 74:386.
  17. Demmy TL, Curtis JJ, Boley TM, et al. Diagnostic and therapeutic thoracoscopy: lessons from the learning curve. Am J Surg 1993; 166:696.
  18. Neragi-Miandoab S, Linden PA, Ducko CT, et al. VATS pericardiotomy for patients with known malignancy and pericardial effusion: survival and prognosis of positive cytology and metastatic involvement of the pericardium: a case control study. Int J Surg 2008; 6:110.
  19. Ng CS, Yim AP. Technical advances in mediastinal surgery: videothoracoscopic approach to posterior mediastinal tumors. Thorac Surg Clin 2010; 20:297.
  20. Pompeo E, Mancini F, Ippolito E, Mineo TC. Videothoracoscopic approach to the spine in idiopathic scoliosis. Thorac Surg Clin 2010; 20:311.
  21. Song IH, Yum S, Choi W, et al. Clinical application of single incision thoracoscopic surgery: early experience of 264 cases. J Cardiothorac Surg 2014; 9:44.
  22. Chung JH, Lee SH, Kim KT, et al. Optimal timing of thoracoscopic drainage and decortication for empyema. Ann Thorac Surg 2014; 97:224.
  23. Zahid I, Nagendran M, Routledge T, Scarci M. Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. Curr Opin Pulm Med 2011; 17:255.
  24. Battoo A, Jahan A, Yang Z, et al. Thoracoscopic pneumonectomy: an 11-year experience. Chest 2014; 146:1300.
  25. Carballo M, Maish MS, Jaroszewski DE, Holmes CE. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009; 4:13.
  26. Hennon MW, Dexter EU, Huang M, et al. Does Thoracoscopic Surgery Decrease the Morbidity of Combined Lung and Chest Wall Resection? Ann Thorac Surg 2015; 99:1929.
  27. Kimura T, Inoue M, Kadota Y, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg 2013; 44:e214.
  28. Leshnower BG, Miller DL, Fernandez FG, et al. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 2010; 89:1571.
  29. Li Y, Wang J. Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients. ANZ J Surg 2013; 83:664.
  30. Limmer KK, Kernstine KH. Minimally invasive and robotic-assisted thymus resection. Thorac Surg Clin 2011; 21:69.
  31. Linden D, Linden K, Oparka J. In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection? Interact Cardiovasc Thorac Surg 2014; 19:107.
  32. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 2012; 256:95.
  33. Luketich JD, Pennathur A, Franchetti Y, et al. Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study. Ann Surg 2015; 261:702.
  34. Hofferberth SC, Cecchin F, Loberman D, Fynn-Thompson F. Left thoracoscopic sympathectomy for cardiac denervation in patients with life-threatening ventricular arrhythmias. J Thorac Cardiovasc Surg 2014; 147:404.
  35. Oncel M, Sadi Sunam G, Erdem E, et al. Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases. Cardiovasc J Afr 2013; 24:137.
  36. Agrawal D, Meekison L, Walker WS. Long-term clinical results of thoracoscopic Heller's myotomy in the treatment of achalasia. Eur J Cardiothorac Surg 2008; 34:423.
  37. Hu X, Lee H. Complete thoracoscopic enucleation of giant leiomyoma of the esophagus: a case report and review of the literature. J Cardiothorac Surg 2014; 9:34.
  38. Jiang G, Zhao H, Yang F, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus 2009; 22:279.
  39. Kilic A, Schuchert MJ, Awais O, et al. Surgical management of epiphrenic diverticula in the minimally invasive era. JSLS 2009; 13:160.
  40. Ahmed N, Chung R. Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg 2010; 76:1236.
  41. Billeter AT, Druen D, Franklin GA, et al. Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review. Langenbecks Arch Surg 2013; 398:515.
  42. Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc 2009; 24:44.
  43. Shaikhrezai K, Thompson AI, Parkin C, et al. Video-assisted thoracoscopic surgery management of spontaneous pneumothorax--long-term results. Eur J Cardiothorac Surg 2011; 40:120.
  44. Lonner BS, Auerbach JD, Levin R, et al. Thoracoscopic anterior instrumented fusion for adolescent idiopathic scoliosis with emphasis on the sagittal plane. Spine J 2009; 9:523.
  45. Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty. World J Surg 2013; 37:1661.
  46. Rothenberg SS. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience. Dis Esophagus 2013; 26:359.
  47. van der Zee DC, Straver M. Thoracoscopic aortopexy for tracheomalacia. World J Surg 2015; 39:158.
  48. Yu D, Han Y, Zhou S, et al. Video-assisted thoracic bronchial sleeve lobectomy with bronchoplasty for treatment of lung cancer confined to a single lung lobe: a case series of Chinese patients. J Cardiothorac Surg 2014; 9:67.
  49. Zhao G, Dong C, Yang M, et al. Totally thoracoscopic tracheoplasty for a squamous cell carcinoma of the mediastinal trachea. Ann Thorac Surg 2014; 98:1109.
  50. Straughan DM, Fontaine JP, Toloza EM. Robotic-Assisted Videothoracoscopic Mediastinal Surgery. Cancer Control 2015; 22:326.
  51. Cardillo G, Carleo F, Carbone L, et al. Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication. Eur J Cardiothorac Surg 2009; 36:914.
  52. Kohman LJ. Thoracoscopy for the evaluation and treatment of pleural space disease. Chest Surg Clin N Am 1994; 4:467.
  53. Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J 2006; 28:409.
  54. Freeman RK, Van Woerkom J, Vyverberg A, Ascioti AJ. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 2009; 88:1112.
  55. Versteegh MI, Braun J, Voigt PG, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 2007; 32:449.
  56. Zwischenberger BA, Kister N, Zwischenberger JB, Martin JT. Laparoscopic Robot-Assisted Diaphragm Plication. Ann Thorac Surg 2016; 101:369.
  57. Kim DH, Joo Hwang J, Kim KD. Thoracoscopic diaphragmatic plication using three 5 mm ports. Interact Cardiovasc Thorac Surg 2007; 6:280.
  58. Kocher TM, Gürke L, Kuhrmeier A, Martinoli S. Misleading symptoms after a minor blunt chest trauma. Thoracoscopic treatment of diaphragmatic rupture. Surg Endosc 1998; 12:879.
  59. Moon SW, Wang YP, Kim YW, et al. Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg 2000; 70:299.
  60. Lee JM, Wang CH, Huang PM, et al. Enduring effects of thoracoscopic Heller myotomy for treating achalasia. World J Surg 2004; 28:55.
  61. Jang KM, Lee KS, Lee SJ, et al. The spectrum of benign esophageal lesions: imaging findings. Korean J Radiol 2002; 3:199.
  62. Champion JK. Thoracoscopic Belsey fundoplication with 5-year outcomes. Surg Endosc 2003; 17:1212.
  63. Nguyen NT, Schauer PR, Hutson W, et al. Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure. Surg Laparosc Endosc 1998; 8:185.
  64. Fabian T, McKelvey AA, Kent MS, Federico JA. Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy. Surg Endosc 2007; 21:1667.
  65. Fabian T, Martin J, Katigbak M, et al. Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions. Surg Endosc 2008; 22:2485.
  66. Grant GP, Szirth BC, Bennett HL, et al. Effects of prone and reverse trendelenburg positioning on ocular parameters. Anesthesiology 2010; 112:57.
  67. Decker G, Coosemans W, De Leyn P, et al. Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg 2009; 35:13.
  68. Atkins BZ, Fortes DL, Watkins KT. Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk. Dysphagia 2007; 22:49.
  69. Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 2007; 245:232.
  70. Straughan DM, Azoury SC, Bennett RD, et al. Robotic-Assisted Esophageal Surgery. Cancer Control 2015; 22:335.
  71. Sarkaria IS, Rizk NP. Robotic-assisted minimally invasive esophagectomy: the Ivor Lewis approach. Thorac Surg Clin 2014; 24:211.
  72. Lehenbauer D, Kernstine KH. Robotic esophagectomy: modified McKeown approach. Thorac Surg Clin 2014; 24:203.
  73. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379:1887.
  74. Sihag S, Wright CD, Wain JC, et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre. Eur J Cardiothorac Surg 2012; 42:430.
  75. Collura CA, Johnson JN, Moir C, Ackerman MJ. Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery. Heart Rhythm 2009; 6:752.
  76. Gillinov AM, Mihaljevic T. Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation: commentary. Heart 2009; 95:1110.
  77. Mack MJ. Minimally invasive cardiac surgery. Surg Endosc 2006; 20 Suppl 2:S488.
  78. Murzi M, Kallushi E, Tiwari KK, et al. Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass grafts. Interact Cardiovasc Thorac Surg 2009; 9:29.
  79. Cheng YL, Lee SC, Huang TW, Wu CT. Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum. Eur J Cardiothorac Surg 2008; 34:1057.
  80. Kelly RE Jr, Shamberger RC, Mellins RB, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 2007; 205:205.
  81. Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg 2008; 17:209.
  82. Schalamon J, Pokall S, Windhaber J, Hoellwarth ME. Minimally invasive correction of pectus excavatum in adult patients. J Thorac Cardiovasc Surg 2006; 132:524.
  83. Seder CW, Hanna K, Lucia V, et al. The safe transition from open to thoracoscopic lobectomy: a 5-year experience. Ann Thorac Surg 2009; 88:216.
  84. Toker A, Tanju S, Ziyade S, et al. Learning curve in videothoracoscopic thymectomy: how many operations and in which situations? Eur J Cardiothorac Surg 2008; 34:155.
  85. Toker A, Tanju S, Sungur Z, et al. Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: results of 90 patients. Surg Endosc 2008; 22:912.
  86. Khan NU, Yonan N. Does preoperative computed tomography reduce the risks associated with re-do cardiac surgery? Interact Cardiovasc Thorac Surg 2009; 9:119.
  87. Shah AA, Worni M, Onaitis MW, et al. Thoracoscopic left upper lobectomy in patients with internal mammary artery coronary bypass grafts. Ann Thorac Surg 2014; 98:1207.
  88. Yang C, Mo L, Ma Y, et al. A comparative analysis of lung cancer patients treated with lobectomy via three-dimensional video-assisted thoracoscopic surgery versus two-dimensional resection. J Thorac Dis 2015; 7:1798.
  89. Dickhoff C, Li WW, Symersky P, Hartemink KJ. Feasibility of 3-dimensional video-assisted thoracic surgery (3D-VATS) for pulmonary resection. Ann Surg Innov Res 2015; 9:8.
  90. Li Z, Li JP, Qin X, et al. Three-dimensional vs two-dimensional video assisted thoracoscopic esophagectomy for patients with esophageal cancer. World J Gastroenterol 2015; 21:10675.
  91. Bagan P, De Dominicis F, Hernigou J, et al. Complete thoracoscopic lobectomy for cancer: comparative study of three-dimensional high-definition with two-dimensional high-definition video systems †. Interact Cardiovasc Thorac Surg 2015; 20:820.
  92. Ibrahim M, Menna C, Maurizi G, et al. Impact of Transcollation technology in thoracic surgery: a retrospective study. Eur J Cardiothorac Surg 2016; 49:623.
  93. Parekh K, Rusch V, Bains M, et al. VATS port site recurrence: a technique dependent problem. Ann Surg Oncol 2001; 8:175.
  94. Pinzon D, Byrns S, Zheng B. Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery. Surg Innov 2016; 23:415.
  95. Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg 2014; 20:93.
  96. 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; 1:3.
  97. Adams RD, Bolton WD, Stephenson JE, et al. Initial multicenter community robotic lobectomy experience: comparisons to a national database. Ann Thorac Surg 2014; 97:1893.
  98. Paul S, Jalbert J, Isaacs AJ, et al. Comparative effectiveness of robotic-assisted vs thoracoscopic lobectomy. Chest 2014; 146:1505.
  99. 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.
  100. Demir A, Ayalp K, Ozkan B, et al. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions. Interact Cardiovasc Thorac Surg 2015; 20:304.
  101. Swanson SJ, Miller DL, McKenna RJ Jr, et al. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: results from a multihospital database (Premier). J Thorac Cardiovasc Surg 2014; 147:929.
  102. Louie BE, Farivar AS, Aye RW, Vallières E. Early experience with robotic lung resection results in similar operative outcomes and morbidity when compared with matched video-assisted thoracoscopic surgery cases. Ann Thorac Surg 2012; 93:1598.
  103. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Evolving from conventional video-assisted thoracoscopic lobectomy to uniportal: the story behind the evolution. J Thorac Dis 2014; 6:S599.
  104. Yamashita S, Yoshida Y, Iwasaki A. Robotic Surgery for Thoracic Disease. Ann Thorac Cardiovasc Surg 2016; 22:1.
  105. Boffa DJ, Kosinski AS, Paul S, et al. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg 2012; 94:347.
  106. Lee PC, Kamel M, Nasar A, et al. Lobectomy for Non-Small Cell Lung Cancer by Video-Assisted Thoracic Surgery: Effects of Cumulative Institutional Experience on Adequacy of Lymphadenectomy. Ann Thorac Surg 2016; 101:1116.
  107. Decaluwé H, Stanzi A, Dooms C, et al. Central tumour location should be considered when comparing N1 upstaging between thoracoscopic and open surgery for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 50:110.
  108. Swanson SJ, Herndon JE 2nd, D'Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. J Clin Oncol 2007; 25:4993.
  109. Qureshi I, Nason KS, Luketich JD. Is minimally invasive esophagectomy indicated for cancer? Expert Rev Anticancer Ther 2008; 8:1449.
  110. Sagawa M, Sato M, Sakurada A, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 2002; 73:900.
  111. Watanabe A, Koyanagi T, Obama T, et al. Assessment of node dissection for clinical stage I primary lung cancer by VATS. Eur J Cardiothorac Surg 2005; 27:745.
  112. Bachmann K, Burkhardt D, Schreiter I, et al. Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc 2008; 22:2470.
  113. Kang CH, Hwang Y, Lee HJ, et al. Robotic Thymectomy in Anterior Mediastinal Mass: Propensity Score Matching Study With Transsternal Thymectomy. Ann Thorac Surg 2016; 102:895.
  114. Cheng YJ, Hsu JS, Kao EL. Characteristics of thymoma successfully resected by videothoracoscopic surgery. Surg Today 2007; 37:192.
  115. Pompeo E, Tacconi F, Massa R, et al. Long-term outcome of thoracoscopic extended thymectomy for nonthymomatous myasthenia gravis. Eur J Cardiothorac Surg 2009; 36:164.
  116. Meyer DM, Herbert MA, Sobhani NC, et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches. Ann Thorac Surg 2009; 87:385.
  117. Marulli G, Maessen J, Melfi F, et al. Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg 2016; 5:18.
  118. De Giacomo T, Diso D, Anile M, et al. Thoracoscopic resection of mediastinal bronchogenic cysts in adults. Eur J Cardiothorac Surg 2009; 36:357.
  119. Demmy TL, Krasna MJ, Detterbeck FC, et al. Multicenter VATS experience with mediastinal tumors. Ann Thorac Surg 1998; 66:187.
  120. Kang CU, Cho DG, Cho KD, Jo MS. Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings. Eur J Cardiothorac Surg 2008; 34:216.
  121. Landreneau RJ, Dowling RD, Ferson PF. Thoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest 1992; 102:1288.
  122. Liu HP, Yim AP, Wan J, et al. Thoracoscopic removal of intrathoracic neurogenic tumors: a combined Chinese experience. Ann Surg 2000; 232:187.
  123. Awais O, Reidy MR, Mehta K, et al. Electromagnetic Navigation Bronchoscopy-Guided Dye Marking for Thoracoscopic Resection of Pulmonary Nodules. Ann Thorac Surg 2016; 102:223.
  124. Zhao ZR, Lau RW, Ng CS. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis 2016; 8:S319.
  125. Stephenson JA, Mahfouz A, Rathinam S, et al. A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited. Lung Cancer Int 2015; 2015:235720.
  126. Whitson BA, D'Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg 2008; 86:1735.
  127. Watanabe A, Koyanagi T, Ohsawa H, et al. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 2005; 138:510.
  128. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 2006; 81:421.
  129. Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 2006; 244:420.
  130. Demmy TL, Plante AJ, Nwogu CE, et al. Discharge independence with minimally invasive lobectomy. Am J Surg 2004; 188:698.
  131. Farjah F, Wood DE, Mulligan MS, et al. Safety and efficacy of video-assisted versus conventional lung resection for lung cancer. J Thorac Cardiovasc Surg 2009; 137:1415.
  132. Flores RM, Park BJ, Dycoco J, et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg 2009; 138:11.
  133. Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): Multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg 2012; 1:24.
  134. Friscia ME, Zhu J, Kolff JW, et al. Cytokine response is lower after lung volume reduction through bilateral thoracoscopy versus sternotomy. Ann Thorac Surg 2007; 83:252.
  135. Fukunaga T, Kidokoro A, Fukunaga M, et al. Kinetics of cytokines and PMN-E in thoracoscopic esophagectomy. Surg Endosc 2001; 15:1484.
  136. Ettinger DS, Cox JD, Ginsberg RJ, et al. NCCN Non-Small-Cell Lung Cancer Practice Guidelines. The National Comprehensive Cancer Network. Oncology (Williston Park) 1996; 10:81.
  137. Farjah F, Flum DR, Varghese TK Jr, et al. Surgeon specialty and long-term survival after pulmonary resection for lung cancer. Ann Thorac Surg 2009; 87:995.
  138. Goodney PP, Lucas FL, Stukel TA, Birkmeyer JD. Surgeon specialty and operative mortality with lung resection. Ann Surg 2005; 241:179.
  139. Schipper PH, Diggs BS, Ungerleider RM, Welke KF. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg 2009; 88:1566.
  140. Silvestri GA, Handy J, Lackland D, et al. Specialists achieve better outcomes than generalists for lung cancer surgery. Chest 1998; 114:675.
  141. Scheel PJ 3rd, Crabtree TD, Bell JM, et al. Does surgeon experience affect outcomes in pathologic stage I lung cancer? J Thorac Cardiovasc Surg 2015; 149:998.
  142. David G, Gunnarsson CL, Moore M, et al. Surgeons' volume-outcome relationship for lobectomies and wedge resections for cancer using video-assisted thoracoscopic techniques. Minim Invasive Surg 2012; 2012:760292.
  143. Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J 2006; 28:637.
  144. Hazelrigg SR, Boley TM, Magee MJ, et al. Comparison of staged thoracoscopy and median sternotomy for lung volume reduction. Ann Thorac Surg 1998; 66:1134.
  145. Ko CY, Waters PF. Lung volume reduction surgery: a cost and outcomes comparison of sternotomy versus thoracoscopy. Am Surg 1998; 64:1010.
  146. McKenna RJ Jr, Benditt JO, DeCamp M, et al. Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery. J Thorac Cardiovasc Surg 2004; 127:1350.
  147. Georghiou GP, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions. Ann Thorac Surg 2005; 80:607.
  148. O'Brien PK, Kucharczuk JC, Marshall MB, et al. Comparative study of subxiphoid versus video-thoracoscopic pericardial "window". Ann Thorac Surg 2005; 80:2013.
  149. Denk PM, Gatta P, Swanström LL. Multimedia article. Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax. Surg Endosc 2008; 22:2742.
  150. Mine S, Udagawa H, Kinoshita Y, Makuuchi R. Post-esophagectomy chylous leakage from a duplicated left-sided thoracic duct ligated successfully with left-sided video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2008; 7:1186.
  151. Bachmann K, Standl N, Kaifi J, et al. Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach. Surg Endosc 2009; 23:1587.
  152. Krasna MJ, Demmy TL, McKenna RJ, Mack MJ. Thoracoscopic sympathectomy: the U.S. experience. Eur J Surg Suppl 1998; :19.
  153. Sugimura H, Spratt EH, Compeau CG, et al. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137:1370.
  154. Paul S, Isaacs AJ, Treasure T, et al. Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database. BMJ 2014; 349:g5575.
  155. McKenna RJ Jr, Mahtabifard A, Pickens A, et al. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy. Ann Thorac Surg 2007; 84:1663.
  156. Imperatori A, Rotolo N, Gatti M, et al. Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg 2008; 6 Suppl 1:S78.
  157. Cheung KM, Al Ghazi S. Approach-related complications of open versus thoracoscopic anterior exposures of the thoracic spine. J Orthop Surg (Hong Kong) 2008; 16:343.
  158. Solaini L, Prusciano F, Bagioni P, et al. Video-assisted thoracic surgery (VATS) of the lung: analysis of intraoperative and postoperative complications over 15 years and review of the literature. Surg Endosc 2008; 22:298.
Topic Outline