What is difficult about doing video-assisted thoracic surgery (VATS)? A retrospective study comparing VATS anatomical resection and conversion to thoracotomy for lung cancer in a university-based hospital

Video-assisted thoracic surgery (VATS) lobectomy is an acceptable alternative to thoracotomy lobectomy for early-stage lung cancer (1,2). However, conversion to thoracotomy is sometimes inevitable due to intraoperative massive bleeding, pleural adhesion, enlarged or fibrocalcified lymph node, or anatomic variations (3-5). The conversion rate varies from 4% to 23% (4-8) because of diverse study periods or populations but is usually higher in the hospital where smaller cases of surgical resection are performed or due to surgeons being in the learning curve (6,7). Moreover, this presents a large amount of stress because nearly half of conversions to thoracotomy are performed in emergency situations (7-9)