One, two, three or four ports… does it matter? Priorities in lung cancer surgery

Lung cancer surgeons can choose from an arsenal of techniques when offering minimal invasive surgery to their patients. These can be classified by the primary vantage point, the use of a robot, the use of a utility-incision (vs. total thoracoscopic), the location of the extraction point, the sequence of transection (hilum-first vs. fissure-first), the size of the ports or the number of ports. Combinations are possible and this results in a wealth of techniques. Obviously, surgeons with—sometimes without—experience like their own technique and tend to defend them. Some techniques are positioned as ‘ultra-minimal invasive’ such as uniportal surgery, micro-lobectomy (5 mm instruments and subxyphoidal extraction) or complete subxyphoidal resections. Subjectively, the clinical importance might make sense. But, hard objective data are missing to date.