From the Thoracoscope to the Robot: The Evolving Landscape of Minimally Invasive Pulmonary Surgery

Surgical resection is the main curative option for non-small-cell lung cancer. Pulmonary resections have historically been performed through a highly morbid open thoracotomy. Minimally invasive approaches to pulmonary resection have revolutionized the field with reduced perioperative morbidity, including less postoperative pain, length-of-stay, and complications, while potentially enhancing oncologic outcomes. In its current generation, robotically performed video-assisted thoracoscopic surgery (R-VATS) offers numerous advantages over traditional VATS and is increasingly becoming the standard of care. In this review, we highlight the technical and clinical advantages of R-VATS compared to VATS and traditional thoracotomy. We reflect on emerging advancements in the utilization of the minimally invasive platform for single-anesthetic marking and resection of pulmonary nodules, the integration of artificial intelligence and radiomics to augment preoperative planning, and the expanding role of single-incision robotic surgery. Lastly, we discuss the financial considerations of implementing a robotic thoracic platform and identify opportunities to optimize costs.