Imagine a very valuable bonsai (yellow mountain pine for example) inside an LV leather bag (assuming it is the latest design leather ball shape with no opening), your task now is to prune off a rotten branch on the yellow mountain pine. The easy way to do this is to cut a large slit in the LV to ensure that your hand with the scissors can get deep inside the purse and finish the task with one scissor. It’s easy, but you completely ignore the value of the LV and the rustic client will complain that you have no taste. This is what traditional open heart surgery does, your chest wall structure (muscles and ribs) is the expensive LV bag, rib fractures and muscle transection will cause you to lose about 10% of your lung function, and of course aesthetics is an important factor. Small scars (under 2 cm) will make you more manly, and a scar of more than 10 cm will be nothing but scary. In 1912 Dr. Jacobeus of Sweden, who must have been a man of great taste, made a small 2 cm incision in the chest wall of a patient with pleural lesions, probed a metal tube into the chest cavity, and removed small pieces of tissue to clarify the diagnosis. Although it was just a peek between the tubes, it heralded the era of minimally invasive surgery in thoracic surgery. It was only in the 1990s that video-assisted thoracoscopic surgery VATS was developed on a large scale with the advances in endoscopic camera systems and the availability of endoscopic cutters and sutures and other endoscopic instruments (scissors and separating forceps, etc.). Returning to the analogy mentioned above, it is now possible to make 1-4 small 1-2 cm holes in the LV and use high-tech instruments (familiar footage from Hollywood movies, used by the bad guys to steal jewelry and by the good guys to defuse bombs) to elegantly and subtly remove the decaying branches, preserving the LV’s ethos and adding a sense of vicissitude. Robot-assisted thoracoscopic surgery (robotic-assisted thoracoscopic surgery, RATS) technology is currently the highest end of minimally invasive surgery technology, not to say that your life will be given to the machine, the procedure is wrong there is a risk of being chopped into meat as a bun, it is not yet advanced to this extent. The first benefit is that the machine’s wrist is more flexible, there are 7 dimensions of movement parameters, left and right hand suture freely, the whole of a hand to hand combat, martial arts instantly enhance. Another is the 3-dimensional imaging, think about your first time watching 3D movies, three-dimensional sense of surgery has a deadly important, you can close one eye and then try to insert the pen into the pen sleeve, you fail at the cost of surgical ink, for surgeons, the ink into the patient’s blood. There is another reason I personally like it very much, I can sit and open the surgery, considering my 1, 90 height, I have been worried that long-term upright bow back surgery, my own surgical career will soon be ruined in cervical and lumbar spondylosis. Now thanks to the remote operation feature, the main surgeon can get up and move around during the assistant’s instrument change, and you can have a cup of coffee before continuing the battle if you wish. The system also has an excellent anti-fibrillation function, so that each surgeon’s hand is truly as firm as a surgeon, and it is estimated that the surgeon’s professional life can be extended to 80 years. The system is self-learning and, like Deep Blue, will one day be able to compete with the best surgeons, when it can truly be called a robotic surgery system. To summarize, minimally invasive thoracic surgery must have the following basic features: 1. not to open the ribs 2. not to break the entire muscle As for the number, length and location of the holes you make in the LV, each surgeon has his own habits and cannot force uniformity. The advantages of minimally invasive thoracic surgery are: fast recovery and low impact on lung function. Patients in the middle stage can enter the next step of radiotherapy as soon as possible, and early stage patients statistically have better results than traditional open-heart surgery. Less interference with the autoimmune system, the tumor is ultimately controlled by the patient’s own immune system. Some studies have shown that the tissue reconstruction accompanying after large surgical trauma will make the immunity of the body decrease and promote the formation of metastatic re-vascularization and accelerate the progress. This is commonly known as folklore, tumors run when they see the knife. Disadvantages: Deadly expensive, standard VATS radical lung cancer surgery can cost up to 40-50,000 and RATS nearly 100,000. Don’t blame our doctors, but to tell you a fact, the reason why foreign countries promote minimally invasive technology is to reduce medical costs. The resulting oddity is that the cost of surgery abroad is in descending order of RATS, VATS, and conventional open surgery, which is the exact opposite of ours. If you ask why, it is because we do not have enough medical device research and development capabilities, and all minimally invasive devices are imported from abroad. In addition, Chinese doctors will tell you sadly, because the labor cost of Chinese doctors is seriously underestimated in China. The 50,000 you give to the hospital, of which I was paid less than 500 yuan. I am really sorry that I got my PhD after 10 years of study and 20 years of clinical practice. So the next time a doctor recommends minimally invasive surgery to you, remember that it is really for your own good, because it is several times more difficult and risky for the doctor, without any change in income, foolishly for their own little intoxication. If this day does come, who will suffer the most?