VATS, robotic lobectomy and microlobectomy—the future is just ahead?

Video assisted thoracoscopic surgery (VATS) lobectomies have been instrumental in the evolution of thoracic surgical oncology since its introduction in the early 90s. Although there is no robust data to confirm or refute its superiority over open conventional lobectomy, there have been a number of meta-analyses which have shown that VATS is safe and feasible for those undergoing radical resection for cancer. Over the years, VATS lobectomy has continued to evolve with newer techniques, less ports and better instruments. There is now an interest in performing uniportal VATS lobectomy and this is now moving to one without a need for incision in the intercostal space. Microlobectomy, originally envisaged by a group of surgeons from 6 different centres and involves using subcentimeter incisions alongside a subxiphoid utility port. Some of the technical disadvantages of VATS are that the images are 2-dimensional (2D), there is limited depth perception; and manoeuvring rigid instruments within the limited confines of the chest can make dissection difficult. The advent of robotic lobectomy has addressed some of these problems. The 3D vision is unparalleled, the endowrist seamLessly mimic human hand movements and the instrument movement within the chest is fluid. However, the high capital costs may deter smaller centres from introducing this service, especially when working within a limited budget in the public hospital. This can be circumvented by ensuring that the robot is used in a multi-specialty setting and concentrated in a few high volume tertiary centres.