Evolving Paradigms in Video-Assisted Thoracoscopic Surgery for Lung Cancer: Techniques, Outcomes, and Emerging Technologies

Abstract

Background: Video-Assisted Thoracoscopic Surgery (VATS) has transformed lung cancer management by enabling minimally invasive approaches with improved perioperative outcomes. However, rapid advancements in surgical techniques and integration with emerging technologies necessitate a comprehensive synthesis of current evidence.

Objectives: This review aims to evaluate the evolving paradigms of VATS in lung cancer, including comparisons between uniportal and multiportal techniques, assessment against robotic-assisted thoracic surgery (RATS), and analysis of clinical outcomes and technological innovations.

Methods: A narrative review was conducted using a structured literature search across major databases, including retrospective studies, prospective trials, meta-analyses, and consensus reports published over the past two decades. Relevant studies were selected based on predefined inclusion criteria and analyzed qualitatively.

Results and Discussions: Evidence indicates that uniportal VATS is increasingly adopted, offering reduced postoperative pain, shorter hospital stays, and comparable oncological outcomes to multiportal VATS and open surgery. RATS demonstrates enhanced surgical precision and improved lymph node dissection with favorable recovery profiles, although associated with higher costs and technical demands. Overall, minimally invasive approaches reduce perioperative complications and improve recovery, but limitations persist regarding technical complexity, cost-effectiveness, and long-term outcomes.

Conclusion: VATS continues to evolve as a safe and effective modality in lung cancer surgery. Integration with advanced technologies enhances surgical performance; however, further standardized protocols and high-quality studies are required to optimize clinical implementation.

Keyword: lung cancer, minimally invasive surgery, robotic-assisted thoracic surgery, surgical outcomes, VATS

Latar Belakang: Video-Assisted Thoracoscopic Surgery (VATS) telah merevolusi penatalaksanaan kanker paru melalui pendekatan invasif minimal yang memberikan hasil perioperatif yang lebih baik. Namun, perkembangan teknik bedah dan integrasi teknologi baru menuntut sintesis bukti yang komprehensif.

Tujuan: Tinjauan ini bertujuan untuk mengevaluasi perkembangan VATS dalam kanker paru, termasuk perbandingan teknik uniportal dan multiportal, evaluasi terhadap robotic-assisted thoracic surgery (RATS), serta analisis luaran klinis dan inovasi teknologi.

Metode: Literature review dilakukan melalui pencarian terstruktur pada berbagai database yang mencakup studi retrospektif, uji prospektif, meta-analisis, dan laporan konsensus dalam dua dekade terakhir. Studi yang relevan dipilih berdasarkan kriteria inklusi dan dianalisis secara kualitatif.

Pembahasan: Uniportal VATS menunjukkan peningkatan penggunaan dengan keunggulan berupa nyeri pascaoperasi lebih rendah, lama rawat lebih singkat, serta luaran onkologis yang sebanding dengan teknik multiportal dan operasi terbuka. RATS memberikan presisi bedah yang lebih tinggi dan diseksi kelenjar getah bening yang lebih optimal, namun dengan biaya lebih tinggi dan kebutuhan pelatihan khusus. Secara keseluruhan, pendekatan invasif minimal menurunkan komplikasi perioperatif dan mempercepat pemulihan, meskipun masih terdapat keterbatasan dalam kompleksitas teknik, efektivitas biaya, dan data jangka panjang.

Kesimpulan: VATS merupakan metode yang aman dan efektif dalam pembedahan kanker paru yang terus berkembang. Integrasi teknologi meningkatkan performa bedah, namun diperlukan standarisasi protokol dan penelitian berkualitas tinggi untuk optimalisasi implementasi klinis.

Kata kunci: bedah invasif minimal, kanker paru, luaran bedah, RATS