Steps in the development of a VATS lobectomy program.

Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed in recent decades for the treatment of non-small cell lung cancer (NSCLC). Although trials have shown this procedure to be safe and feasible a VATS approach for lobectomy has not been widely used yet. Surgeons can go beyond this limit by following a specific operative plan focused on learning the minimally invasive technique in centers of excellence and then including: a pre-operative phase based on the radioclinical assessments and an operating phase designed to develop a methodical approach to VATS technique. At the beginning it's recommended to follow a learning curve with careful selection of patients keeping in mind that intraoperative complications may occur even later, especially in presence of clinical nodal disease or significant calcification on preoperative CT scan, which represents the main reason for conversion from VATS to thoracotomy.