Troubleshooting in advanced VATS procedures

Since the introduction of VATS lobectomy in 1991 by Roviaro, the initial implementation of VATS lobectomy as a standard of care for lung cancer patients was slow (1). The main concern from the surgical community was the risk of uncontrollable bleeding from the pulmonary artery (PA) with potentially fatal outcome (2). Expert centres adopted and refined the technique (3-5). The recommendations for surgeons embarking on a VATS program were to begin with easier cases to minimize the risk of uncontrollable bleeding from the PA.