Are video-assisted thoracoscopic surgery (VATS) and robotic video-assisted thoracic surgery (RVATS) for pulmonary resection ready for prime time?

Although video-assisted thoracoscopic surgery (VATS) was described twenty years ago, it only accounts for 2-5% of all pulmonary lobectomies performed in the United States and the United Kingdom (1). In addition, nearly 80% of VATS cases performed take place in specialty academic centers (2). The reasons for the lack of widespread acceptance are (I) the perceived complexity of the technique, (II) inadequate instrumentation and resources, and (III) concern regarding the potential compromise of safe surgical and oncologic principles, despite the reported benefits of perioperative pain, cosmesis, pulmonary complications, and length of stay (1).