VATS mediastinal lymph node dissection: surgical technique and literature review

Roviaro et al . performing the f irst video-assisted thoracoscopic surgery (VATS) lobectomy more than 20 years ago (1), started a new era in lung cancer surgery. The better outcomes compared to “open procedures” in terms of less pain, fewer post-operative complications, reduced chest drainage duration and shorter length of stay has, in fact, prompted nearly every thoracic surgeon in the world to at least attempt to VATS approach. The hypothetical differences in terms of local recurrences and long-term survival of VATS approaches compared with open procedures have been overcome (2) and it is proved by then that VATS lobectomy can offer, if performed by skilled surgeons, a better complications rate and the same safety profile of open surgery. Since 2014 we routinely use the biportal VATS technique for lobectomy and, exceptionally, pneumonectomy (3) Review Article