Expanding surgical options for lung cancer treatments

Diagram indicating skin incisions used for VATS Representative image of skin incisions used during a VATS procedure.

Surgical options are expanding for the treatment of patients with lung cancer. One of the most important has been the development of minimally invasive techniques, particularly video-assisted thoracic surgery (VATS).


In VATS, small incisions are made on the chest wall through which a thoracoscopic camera is passed, which allows mediastinal lymph node dissection as well as lobectomy. VATS lobectomy is the preferred care for surgical resection of early-stage (stage I or II) non-small cell lung cancer at Mayo Clinic, where hundreds of these procedures have been performed, with outcomes equivalent to — or better than — those found within the multi-institutional Society of Thoracic Surgeons' database. With ongoing developments in surgical optics and instrumentation continuing to improve this approach, most patients are candidates for thoracoscopic lobectomy.

Robot assistance

Image of robot-assisted surgery with surgeon at control console This surgeon controls instruments in the surgical field while sitting at a console.

Robot-assisted surgery is an emerging field that transcends multiple disciplines; advanced centers, such as Mayo Clinic, are rapidly adapting it to thoracic surgery.

During a robotic procedure, the surgeon operates the surgical instruments while sitting at a console a few feet away from the patient. Robot-assisted surgery offers several potential advantages over conventional procedures. Chief among them are better visualization of the surgical field, improved stability and enhanced mechanics of instruments, with less invasiveness than traditional approaches.

Natural orifices: NOTES

Another emerging advanced technique is natural orifice transluminal endoscopic surgery (NOTES). NOTES is an experimental surgical technique that relies on natural orifices to provide surgical access. Refined in 2009 by a Mayo Clinic gastrointestinal endoscopic surgical team, NOTES is the culmination of years of research into a new generation of endoscopic tools, techniques and physiologic responses, and ushers in a new era of surgery — scarless and pain-free.

The potential that NOTES offers to lung cancer surgery patients is the elimination of skin wounds by using natural anatomic passages for access, such as:

  • Openings in the mouth
  • Endoscopically through the esophagus
  • Endoscopically through an incision in the trachea, which allows access to the pleural space and mediastinum

Several investigational approaches for noncancerous conditions are being explored for NOTES thoracic surgery, including endoscopic myotomies for achalasia.

In its leadership role in the refinement of novel surgical methods, Mayo Clinic is committed to expanding and improving surgical options. The goal is to offer lung cancer patients options that lead to optimal outcomes with the least trauma.