Moving beyond the boundary: the emerging role of video-assisted thoracic surgery for bronchoplastic resections.

Sleeve resections with parenchymal sparing should be attempted whenever possible when operating a central lung cancer rather than performing a pneumonectomy. Long-term results conclusively favored sleeve procedures in improved survival, quality of life, reduced loss in lung function, and improved operative mortality. Therefore, all surgeons should own this technique in their surgical armamentarium. In the last two decades, the minimally invasive surgical approach has slowly gained positions in Thoracic Surgery and now more and more patients ask for a minimally invasive procedure when surgery is required. This technical revolution in thoracic surgery advocates that almost every open procedure could be done in video-assisted thoracic surgery (VATS). Nevertheless, like all other minimally invasive procedures, VATS sleeve lobectomy has a long learning curve. With the skills and the experience derived from major VATS procedures, these demanding surgical operations may also be performed with a minimally invasive approach.