What Is Minimally Invasive Thoracic Surgery?

For many patients, the words chest surgery bring to mind a large incision, rib spreading, significant postoperative discomfort, and a prolonged recovery. Modern thoracic surgery has changed this paradigm.

Minimally invasive thoracic surgery allows many operations to be performed through small incisions rather than a traditional open thoracotomy. At the Institute for Thoracic Surgery, Mark R. Dylewski, M.D., specializes in advanced minimally invasive techniques, including conventional video-assisted thoracoscopic surgery (VATS), uniportal thoracic surgery, and robotic-assisted thoracic surgery.

The objective is not simply to make smaller incisions. The goal is to accomplish the same fundamental surgical objectives—complete removal of disease, appropriate lymph-node assessment, and meticulous control of critical structures—while minimizing the physical trauma associated with accessing the chest.

VATS and Robotic Thoracic Surgery

The two principal minimally invasive platforms used in modern thoracic surgery are video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS).

With VATS, a high-definition camera and specialized instruments are introduced through small incisions between the ribs. The surgeon performs the operation while viewing the surgical field on a monitor.

Robotic-assisted surgery uses a similar minimally invasive access strategy but incorporates a three-dimensional, high-definition camera and articulated instruments controlled directly by the surgeon. The robotic platform provides enhanced visualization and instrument articulation that can be particularly useful when performing precise dissection in the confined space of the chest.

Importantly, the robotic system does not operate independently. Every movement of the instruments is controlled by the surgeon.

What Does the Evidence Show?

The published literature increasingly supports minimally invasive approaches for appropriately selected patients undergoing pulmonary resection.

Large comparative studies and systematic reviews have found that both VATS and robotic lobectomy are associated with favorable perioperative outcomes compared with open thoracotomy. Reported advantages include lower rates of postoperative complications, reduced blood loss and transfusion requirements, shorter hospital stays, and lower perioperative mortality in many comparative analyses. At the same time, studies have generally demonstrated comparable oncologic outcomes, including complete tumor resection and long-term survival, when minimally invasive surgery is appropriately performed.

Importantly, more recent evidence has strengthened the comparison between VATS and open surgery. A 2026 individual-patient-data meta-analysis of randomized trials involving 1,185 patients with early-stage non-small-cell lung cancer found lower overall mortality with VATS lobectomy while disease-free survival was similar between VATS and open surgery.

The literature comparing robotic surgery directly with VATS has generally found the two approaches to have similar perioperative and oncologic outcomes. A 2025 systematic review of randomized trials found no significant differences between robotic and VATS lobectomy in postoperative complications, conversion to thoracotomy, hospital stay, lymph-node yield, blood loss, or long-term disease-free and overall survival, although the authors noted that the randomized evidence remains limited and its certainty is low to very low for several outcomes.

These findings are important because they demonstrate that minimally invasive surgery does not require compromising the fundamental goals of a cancer operation. For appropriately selected patients, VATS and robotic approaches can provide the ability to perform anatomically and oncologically appropriate lung resections while avoiding the greater chest-wall disruption associated with thoracotomy.

Our Approach: Avoiding Open Surgery Whenever Safely Possible

At the Institute for Thoracic Surgery, we believe that a thoracotomy should not be the default approach when a patient's operation can be safely and completely performed through a minimally invasive technique.

Our practice is therefore structured around the principle of minimizing surgical trauma whenever it does not compromise the quality, completeness, or safety of the operation.

Whenever technically and oncologically appropriate, we strive to perform pulmonary and thoracic procedures using VATS, uniportal, or robotic-assisted techniques rather than proceeding directly to an open thoracotomy.

This philosophy does not mean that open surgery has been eliminated from modern thoracic surgery. There are circumstances in which thoracotomy remains the safest or most appropriate approach, including certain locally advanced tumors, complex anatomy, extensive prior surgery, significant bleeding, or situations in which complete resection cannot be safely achieved through a minimally invasive approach.

The decision is therefore not based on technology alone. The objective is to use the least invasive approach that allows the surgeon to perform the operation safely, precisely, and completely.

What Are the Potential Benefits of Avoiding Thoracotomy?

Because minimally invasive surgery avoids the large incision and rib spreading associated with a traditional thoracotomy, patients may experience less disruption of the chest wall and surrounding musculature.

Depending on the operation and the individual patient, potential benefits may include:

• Smaller surgical incisions
• Less chest-wall and muscle disruption
• Reduced postoperative pain
• Lower blood loss and transfusion requirements
• Lower rates of certain postoperative complications
• Earlier mobilization
• Shorter hospitalization
• Faster recovery and return to normal activities
• Smaller surgical scars

These benefits are supported by a substantial body of comparative literature, although individual outcomes vary according to the procedure, underlying disease, patient characteristics, and surgical complexity.

Is Robotic Surgery Better Than VATS?

Robotic surgery and VATS are both established minimally invasive approaches. Current evidence does not demonstrate that one platform is universally superior to the other.

Recent randomized evidence suggests that robotic and VATS lobectomy provide broadly comparable perioperative and oncologic outcomes. Some observational studies have reported advantages with robotic surgery in specific measures, such as lymph-node retrieval or conversion rates, while other studies have found no meaningful differences.

The choice of technique should therefore be individualized. Factors such as the location and extent of disease, anatomy, prior operations, complexity of the procedure, and the surgeon's experience with the particular technique all play an important role.

At the Institute for Thoracic Surgery, robotic technology is one of several tools available to accomplish minimally invasive thoracic surgery. Our goal is not to perform every operation robotically; our goal is to avoid an open operation whenever a minimally invasive approach can safely and completely accomplish the objectives of the procedure.

Conditions Treated With Minimally Invasive Thoracic Surgery

Depending on the diagnosis and complexity of the condition, minimally invasive techniques may be used to treat or diagnose:

• Lung cancer
• Suspicious pulmonary nodules
• Metastatic tumors involving the lung
• Mediastinal tumors and masses
• Pleural disease
• Pneumothorax
• Hyperhidrosis
• Certain esophageal disorders
• Chest-wall and other thoracic conditions
• Selected benign and complex pulmonary disorders

Not every condition can or should be treated minimally invasively. A careful evaluation is necessary to determine whether VATS, robotic-assisted surgery, uniportal surgery, or open surgery provides the safest and most effective treatment.

A Commitment to Minimizing Surgical Trauma

Modern thoracic surgery is no longer defined simply by the ability to remove disease. It also involves how that disease is removed and how much unnecessary trauma can be avoided in the process.

At the Institute for Thoracic Surgery, we combine specialized thoracic expertise with advanced minimally invasive techniques to pursue complete and precise treatment while minimizing disruption to the chest whenever possible.

Our goal is simple: when a thoracic operation can be performed safely and completely without a thoracotomy, we strive to do so.