Do we need any further evidence about minimally invasive thoracic surgery?

In the last decade the development of thoracoscopic approach for early stage lung cancer resections has seen a significant increase, mostly because of the improvement in technology. Some organizations (1) even recommend it in their guidelines. Yet in striking contrast with modern evidence-based practice, such enthusiasm is only underpinned by mostly small, retrospective trials comparing video-assisted thoracoscopic surgery (VATS) to open thoracotomy. By contrast, Bendixen (2) and colleagues’ randomised controlled trial offers an objective assessment in terms of postoperative pain and quality of life (QoL), further consolidating previous evidence. Previous papers compared different type of VATS with different open approaches, thus affecting the quality of the results. Interestingly Bendixen and colleagues compare VATS with anterior thoracotomy, which is considered to be the least invasive open approach. Whilst, intuitively, sparing the latissimus dorsi is likely to be better than posterolateral thoracotomy, demonstrating the advantage of VATS over anterior thoracotomy is a further positive point in this study.