Approach
Description
UK Frequency
Open Thoracotomy
  • Uses a large single incision (10-15cm) and rib spreading to gain entry to the chest
  • Provides good vision and access to the lungs and mediastinum
  • Forcible spreading of the ribs to permit the surgeons hands to enter results in great surgical access trauma and associated morbidity
  • Significant risk of rib fractures and costovertebral joint damage
43.2%
Video-Assisted Minimal Approach (VATS)
  • Uses a main incision (4-6cm), usually with multiple additional incisions, though single port entry is practiced
  • Compared to open thoracotomy associated with significantly
  • less postoperative pain, less intraoperative blood loss, shorter hospital stays and improved postoperative quality of life
  • May offer more limited ability to perform extensive lymph node dissection though 5 years survival outcomes are non-inferior to open surgery
55.8
(10.6% conversion from open)
Robotic-Assisted Minimal Approach (RATS)
  • Uses 3-4 small incisions to access the chest with robotic instruments
  • Offers the theoretical advantage of 3-dimensional vision and instruments with 360-degree dexterity allowing increased ability to perform complicated proceduresAt present has comparable outcomes to VATS
55.8
(10.6% conversion from open)