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Advances in Minimally Invasive Thoracic Surgery: VATS vs RATS
Difference between Emphysema and Empyema
July 15, 2025
Thoracic surgery has undergone a transformative shift over the last two decades. Traditionally performed through open thoracotomy, these procedures are now increasingly done using minimally invasive approaches, offering patients faster recovery, less postoperative pain, and fewer complications. Two of the most advanced techniques in this evolution are Video-Assisted Thoracoscopic Surgery (VATS) and Robot-Assisted Thoracic Surgery (RATS).
Dr. George Karimundackal, a highly regarded thoracic surgeon and lung cancer specialist in Mumbai, India, explains:
“Minimally invasive surgery is no longer the future—it’s the present. VATS and RATS have redefined how we approach thoracic conditions, each bringing its unique advantages to the table.”
With extensive experience in performing both VATS and RATS procedures, Dr. George Karimundackal offers patients evidence-based, personalized care tailored to their condition and surgical needs. His deep understanding of VATS vs RATS allows patients to make informed decisions based on clinical outcomes, anatomical considerations, and recovery expectations.
Wondering what VATS really involves? Let’s delve into the fundamentals of this widely used surgical approach.
What is VATS?
Video‑assisted thoracoscopic surgery (VATS) is a minimally invasive approach where small ports (usually 3‑5 cm) are placed in the chest and a camera plus instruments are used to operate. Surgeons view the operative field on a screen and manually manipulate instruments through these incisions.
VATS has been widely adopted for lung resections, biopsies, and thymectomies. Its advantages include less pain, reduced blood loss, shorter hospital stays, and faster recovery compared to traditional open surgery. VATS also tends to be more cost‑effective and readily available.
Curious about how robotic surgery works in the chest? Let’s explore how RATS is changing the game in thoracic care.
What is RATS?
Robot‑assisted thoracic surgery (RATS) uses robotic systems like the da Vinci platform. Surgeons control robotic arms from a console, manipulating miniature instruments that provide greater dexterity and range of motion than human hands alone.
With high‑definition 3D visualization and tremor filtration, RATS enables precise dissection around critical structures. It’s ideal for complex cases, small tumors, or challenging anatomy—yet it comes with higher costs, longer setup time, and requires specialized training.
How do VATS and RATS stack up in terms of success rates and results? Let’s compare the clinical outcomes of both to better understand their impact.
Comparison: VATS versus RATS — Clinical Outcomes
Both VATS and RATS have been shown to offer excellent oncologic and surgical results:
- Oncologic Effectiveness
VATS and RATS both offer similar oncologic outcomes, including clear surgical margins and strong long-term survival in early-stage lung cancer.
- Lymph Node Dissection
RATS enables more precise and extensive lymph node removal, aiding cancer staging and prognosis due to enhanced visualization and instrument control.
- Operative Time
RATS often takes longer because of setup and docking, but this improves with experience, eventually matching or exceeding VATS efficiency.
- Intraoperative Blood Loss
RATS may result in slightly less blood loss than VATS, thanks to improved surgical precision and control.
- Conversion Rates
Both have low conversion rates to open surgery, though RATS may be better in complex or repeat cases due to enhanced maneuverability.
- Surgical Margin Accuracy
RATS offers improved 3D visibility for accurate margin clearance, though skilled surgeons can achieve excellent results with either approach.
Looking into advanced robotic lung procedures? Reach out to a thoracic expert to explore your options.
Want to know which technique gets patients back on their feet faster? Let’s dive into recovery times, pain levels, and post-surgical complications.
Recovery Metrics and Complications
When comparing recovery, both procedures outperform traditional open thoracotomy. Specific metrics include:
Hospital Stay Duration
- VATS: Patients typically stay 3–5 days post-surgery.
- RATS: May reduce hospital stay slightly further due to less trauma and quicker mobilization.
Postoperative Pain
- VATS: Significantly less pain than open surgery, with faster pain resolution.
- RATS: Often associated with even lower pain scores, particularly due to precision and smaller port placements.
Time to Return to Daily Activities
- VATS: Most patients resume normal activities within 2–3 weeks.
- RATS: Some patients may recover slightly faster due to lower discomfort and improved functional outcomes.
Opioid Use Post-Surgery
- Both VATS and RATS reduce the need for opioids compared to open thoracotomy.
- RATS may result in shorter durations of pain medication usage.
Wound Healing and Scarring
- Both methods offer small incisions and excellent cosmetic outcomes.
- RATS incisions may be even smaller and more strategically placed.
Air Leak Duration
- Both techniques have similar air leak profiles, although meticulous technique in RATS can minimize this risk.
Pulmonary Complications
- Risks like pneumonia, atelectasis, and pleural effusion are low in both procedures.
- Early ambulation in RATS may further reduce pulmonary complication risks.
Infection and Bleeding
- Both techniques significantly lower infection and bleeding risks compared to open surgery.
- Sterile robotic instruments and less tissue trauma in RATS can reduce infection risks marginally.
Reoperation and Readmission Rates
- Both have low reoperation and 30-day readmission rates, provided surgery is performed by experienced teams.
Want to know which technique gets patients back on their feet faster? Let’s dive into recovery times, pain levels, and post-surgical complications.
Recovery Metrics and Complications
When comparing recovery, both procedures outperform traditional open thoracotomy. Specific metrics include:
Need a quick side-by-side overview of both techniques? Let’s summarize VATS vs RATS in a simple, digestible table.
Summary Table – VATS vs RATS
Feature | VATS | RATS |
Visualization | 2D video High‑definition | 3D with magnification |
Instrument dexterity
| Standard thoracoscopic tools | Wristed robotic instruments with tremor filtration |
Cost | Lower setup and per‑case cost | Higher capital investment and instruments |
Operative time | Faster setup and shorter docking time | Longer docking, reduces with experience |
Recovery | Quick, low pain, shorter hospital stay | Possibly even shorter, especially pain levels |
Ideal for complex anatomy | Good for routine tumors | Superior for difficult tumors or re‑operations |
Clinical outcomes | Solid long‑term survival | Equivalent—potentially better precision |
Conclusion
Both VATS and RATS represent significant advances in minimally invasive thoracic surgery. VATS is a well-established, cost‑effective option with proven outcomes. RATS delivers enhanced precision and visualization, especially valuable in complex cases. Discussing your situation with an experienced thoracic surgeon in Mumbai, India, like Dr. George Karimundackal ensures the most appropriate choice.
Choosing between VATS vs RATS depends on tumor stage, anatomy, cost considerations, and surgeon expertise—guidance from a trusted expert can make all the difference.
Ready to take the next step toward better lung health? Connect with a qualified thoracic care provider today.
FAQs
Is RATS better than VATS for lung cancer surgery?
In early-stage lung cancer, both techniques yield similar long-term survival and recurrence rates when performed by experienced surgeons.
Does RATS reduce hospital stay?
RATS may slightly shorten hospital stay compared to VATS, but typical stays are already low for both.
Are long-term outcomes different?
No, long-term oncologic outcomes are equivalent between VATS and RATS for early-stage lung cancer in expert hands.
Is robotic surgery safe?
Yes—RATS is considered safe when performed by trained, experienced surgical teams.
Which technique causes less postoperative pain?
Both offer significantly reduced pain versus open surgery; RATS may edge out VATS slightly in some studies.
Reference links:
https://pubmed.ncbi.nlm.nih.gov/37925829/
https://www.sciencedirect.com/science/article/pii/S0748798323008946
Disclaimer: The information shared in this content is for educational purposes and not for promotional use.