The authors carried out a systematic review of 12 randomised clinical trials to determine if video assisted thoracic surgery (VATS) is associated with better clinical outcomes than thoracotomy for three common thoracic procedures: surgery for pneumothorax, minor resections (wedge and segmental resections), and lobectomy.

Six trials compared VATS with conventional methods for the management of pneumothorax in 327 patients. Four of the trials reported VATS compared with thoracotomy, all with a reduced need for pain medication, and three of these also reported significantly shorter hospital stays. In the other two studies treatment of pneumothorax with VATS was found to be superior to pleural drainage. Three randomised studies (147 patients) compared VATS with conventional thoracotomy for minor resections. Two of these showed that VATS was associated with a reduced need for pain medication, shorter surgery time, and shorter length of stay, while there were no differences in the third study. The evidence from three other randomised controlled trials (196 patients) for benefits associated with VATS for lobectomy was controversial with no studies reporting a substantial advantage.

This review shows that VATS is better tolerated and associated with reduced length of hospital stay in the treatment of pneumothorax and minor resections. It is also superior to pleural drainage for pneumothorax and seems to have a complication profile comparable to that for thoracotomy. However, there is an uncertainty surrounding its application in lobectomies, and further studies are needed.