Nowadays open-chest surgery in the era of fast-track management.

In more than a century, approaches to perform thoracic surgical procedures have had profound changes. A milestone of those changes has been the advent of video-assisted techniques which rapidly evolved from minor diagnostic procedures to the performance by video-assisted thoracic surgery (VATS) of almost any major thoracic surgery. Nevertheless, indications remain for open chest procedures along with the fact that thoracotomy techniques have also evolved to minimally invasive ways, far different from the full thoracotomy of the past. This chapter reviews the evolution of open chest techniques and describes in detail present way to perform low invasiveness open chest surgery leading to excellent results through a mild postoperative course. Unsolved issues regarding the comparison of video-assisted and open techniques, particularly in lung cancer surgery are also considered.