Minimally invasive approaches for lung lobectomy - from VATS to robotic and back!

Background: Recently, minimally invasive approaches for pulmonary lobectomy have gained increasing interest and acceptance. Besides, the "conventional" video-assisted thoracoscopic (VATS) approach, the robotic technique with the da Vinci(TM) surgical system has been evaluated by different groups. Methods: An appraisal of both approaches is given based on profound personal experiences and with reflexion of the current literature. Results: Both techniques have been proven to be feasible and safe. Operating times and costs are higher with the robotic approach, without proven advantages over conventional VATS. Long-term follow-up data support the oncologic accuracy of the VATS approach but are still lacking for the robotic approach. Conclusions: The robotic approach provides no proven benefits over the conventional thoracoscopic approach and is thus not recommended for pulmonary lobectomy.