Robotic lobectomy - the future of minimally invasive lobectomy?

It has been almost 20 years since the first reports of minimally invasive lobectomies appeared. Despite the tremendous amounts of research performed on VATS lobectomy showing its benefit over open thoracotomy, a mere 32% of all lobectomies are performed via this technique in the Society for Thoracic Surgeons database and only 6% in the Nationwide Inpatient Sample (1). So, why is it that in a recent review of clinical stage I lung cancers over 70% were still completed using open thoracotomy?(2). Advocates of an open approach still cite the ability to sample and perform a “more thorough” lymphadenectomy, the instability of the VATS platform and the lack of precision with the fissure-less-dissection VATS technique as reasons to maintain the status quo.