Impact of modern minimally invasive approaches on pulmonary resection outcomes: a narrative review.

BACKGROUND AND OBJECTIVE: Anatomic pulmonary resection remains the gold standard for resectable non-small cell lung cancer (NSCLC). This review evaluates the evolution, intraoperative outcomes, clinical efficiency, oncological adequacy, and cost-effectiveness of minimally invasive thoracic surgery (MITS) relative to traditional open thoracotomy. METHODS: A systematic literature search was conducted in PubMed, Cochrane Library, and Wiley Library for studies published through early 2026, prioritizing randomized controlled trials (RCTs) and large-scale registry analyses comparing video-assisted thoracoscopic surgery (VATS), robotic-assisted thoracic surgery (RVATS), and open thoracotomy. KEY CONTENT AND FINDINGS: MITS (comprising VATS and RVATS) is associated with significantly lower perioperative mortality, reduced postoperative pain, shorter hospital stays, and fewer complications compared to open thoracotomy. While intraoperative conversion remains a risk, robotic platforms exhibit lower conversion rates than VATS in several large series. Oncologically, all three modalities provide equivalent nodal upstaging and disease-free survival (DFS), provided oncological principles are rigorously maintained. While robotic surgery incurs higher procedural costs, these are partially mitigated by reduced postoperative resource utilization. CONCLUSIONS: MITS has become the standard of care for early-stage NSCLC. Recent data suggest that robotic platforms may offer advantages in technical precision and lower conversion rates, although VATS remains a highly cost-effective and efficacious approach. Future innovations in single-port robotics continue to advance the reduction of surgical trauma.