From Thoracotomy to Robotic Platforms in Thoracic Surgery: Technical Evolution, Simulation-Based Training, and Surgical Outcomes.
4 affiliations
- 1Unit of Thoracic Surgery, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy.
- 2Medical Oncology Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy.
- 3Lung Cancer Research Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy.
- 4Unit of Pathology, Azienda Ospedaliera Universitaria Ospedali Riuniti, 71100 Foggia, Italy.
Abstract
Thoracic surgery has progressively moved from open thoracotomy to video-assisted and robot-assisted approaches, reducing access-related trauma while changing the technical environment in which pulmonary resections are performed and taught. This narrative review examines the clinical evolution of open, video-assisted thoracic surgery (VATS), and robot-assisted thoracic surgery (RATS), with particular attention to the evidence supporting their perioperative and oncological outcomes, the learning curves associated with minimally invasive surgery, and the role of simulation-based training. Randomized trials now provide robust evidence that VATS improve postoperative recovery compared with thoracotomy in appropriately selected patients with predominantly early-stage non-small cell lung cancer, without compromising long-term oncological outcomes. Randomized comparisons between RATS and VATS support RATS as an oncologically acceptable minimally invasive alternative and suggest advantages in selected technical endpoints, particularly blood loss and lymph node retrieval, but do not demonstrate consistent superiority in major clinical or survival outcomes. Learning curves vary according to previous experience, case complexity, supervision, institutional volume, and the endpoint used to define competence, making fixed case-number thresholds an incomplete measure of proficiency. Simulation can improve selected technical skills and provide objective performance assessment, although evidence becomes progressively less robust when moving from simulator performance to operating room transfer and patient-level outcomes. Surgical approach, therefore, should be interpreted within a broader framework that includes patient and tumour characteristics, oncological quality, surgical expertise, institutional resources, and structured training.
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BibTeX
@article{piazzolla2026from,
title = {{From Thoracotomy to Robotic Platforms in Thoracic Surgery: Technical Evolution, Simulation-Based Training, and Surgical Outcomes.}},
author = {Michele Piazzolla and Doroty Sampietro and Marco Donatello Delcuratolo and Paolo Nicola Camillo Girotti and Lucia Anna Muscarella and Paola Parente},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193193},
url = {https://europepmc.org/article/MED/42882887},
note = {CC BY},
}
RIS
TY - JOUR
TI - From Thoracotomy to Robotic Platforms in Thoracic Surgery: Technical Evolution, Simulation-Based Training, and Surgical Outcomes.
AU - Michele Piazzolla
AU - Doroty Sampietro
AU - Marco Donatello Delcuratolo
AU - Paolo Nicola Camillo Girotti
AU - Lucia Anna Muscarella
AU - Paola Parente
PY - 2026
DA - 2026/10/02
JO - Cancers
DO - 10.3390/cancers18193193
UR - https://europepmc.org/article/MED/42882887
AB - Thoracic surgery has progressively moved from open thoracotomy to video-assisted and robot-assisted approaches, reducing access-related trauma while changing the technical environment in which pulmonary resections are performed and taught. This narrative review examines the clinical evolution of open, video-assisted thoracic surgery (VATS), and robot-assisted thoracic surgery (RATS), with particular attention to the evidence supporting their perioperative and oncological outcomes, the learning curves associated with minimally invasive surgery, and the role of simulation-based training. Randomized trials now provide robust evidence that VATS improve postoperative recovery compared with thoracotomy in appropriately selected patients with predominantly early-stage non-small cell lung cancer, without compromising long-term oncological outcomes. Randomized comparisons between RATS and VATS support RATS as an oncologically acceptable minimally invasive alternative and suggest advantages in selected technical endpoints, particularly blood loss and lymph node retrieval, but do not demonstrate consistent superiority in major clinical or survival outcomes. Learning curves vary according to previous experience, case complexity, supervision, institutional volume, and the endpoint used to define competence, making fixed case-number thresholds an incomplete measure of proficiency. Simulation can improve selected technical skills and provide objective performance assessment, although evidence becomes progressively less robust when moving from simulator performance to operating room transfer and patient-level outcomes. Surgical approach, therefore, should be interpreted within a broader framework that includes patient and tumour characteristics, oncological quality, surgical expertise, institutional resources, and structured training.
SN - 2072-6694
ER -