Learn about the approaches

Traditional open surgery1

An open approach may be required in certain instances depending on where the tumor is located or if there is extensive scar tissue.

With this approach, a surgeon removes all or part of a lung through a large incision on one side of the chest.

Thoracotomy is a more traditional open surgery approach and was the only surgical option to treat lung cancer — until more advanced medical techniques and equipment were popularized in the 1990s.2

Minimally invasive surgery: video-assisted thoracoscopic surgery (VATS)1

VATS allows your surgeon to access and remove your cancer in a minimally invasive manner. Your surgeon will utilize 1-4 small incisions (2-6 cm) between the ribs to insert a camera and advanced instruments. The scope provides a magnified view, which allows the surgeon to identify the cancerous lung tissue and remove it from the body.

* VATS is associated with reduced cytokine production. Cytokines regulate the immune system. And certain cytokines associated with the body’s inflammatory response have been linked to a better lung cancer prognosis when they are at lower levels.3

Learn about the benefits

Benefits of minimally invasive over open surgery4

Unlike open surgery, VATS doesn’t require rib spreading, so it’s a less invasive procedure. Long-term survival rates with VATS are equal to open thoracotomy for early stage NSCLC and some recent data suggest that the survival may be better. 3,5

Less pain after surgery
Shorter hospital stay
Better immune system response
Better chance of breathing normally
Better quality of life
Shorter exposure to anesthesia
Compare Open Surgery vs Minimally Invasive6 Thoracotomy (traditional open) VATS (minimally invasive)
Pain Incisions and your chest area may be painful for several weeks to months after surgery While pain in the hospital will still occur, it is usually less than that experienced with a thoracotomy
Incision size One large incision 10-15 cm One main incision 4-6 cm (usually 4.5 cm); multiple additional incisions, typically 2-4 cm
Anesthesia General General
Length of hospital stay 6-7 days 3-4 days
Incision placement Traditional open surgery VATS surgery
VATS may not be appropriate for some cases that require greater access to the cancerous tissue. Location of the tumor, size of the tumor, prior chemotherapy or radiation therapy, and prior chest surgery may also limit the use of VATS.
Risks specific to VATS include the possibility of conversion to an open procedure and the associated risks of that open procedure. Your individual risks can be determined in consultation with your surgeon; only your surgeon can determine if a VATS procedure is right for you.

Educate yourself in the fight against lung cancer

An informational guide to help patients understand the diagnosis, staging, and surgical treatment options for lung cancer.


  1. Non-Small-Cell Lung Cancer: Treatment by Stage. Webmd website. Accessed September 27, 2016.
  2. Mack M. Minimally Invasive and Robotic Surgery. JAMA. 2001;285(5):568-572.
  3. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic Lobectomy Is Associated with Lower Morbidity than Open Lobectomy: A Propensity-Matched Analysis from the STS Database. J Thorac Cardiovasc Surg. 2010;139(2):366-378.
  4. Ohtsuka T. Is Major Pulmonary Resection by Video-Assisted Thoracic Surgery an Adequate Procedure in Clinical Stage I Lung Cancer? Chest. 2004;125(5):1742-1746.
  5. Whitson BA, Groth SS, Duval SJ, et al. Surgery for Early-Stage Non-Small Cell Lung Cancer: A Systematic Review of the Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Approaches to Lobectomy. Ann Thorac Surg. 2008;86(6):2008-2016.
  6. Lung Cancer Diseases and Conditions. Cleveland Clinic website. Accessed September 27, 2016.