{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T16:39:26Z","timestamp":1793378366223,"version":"4.5.0"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The rapid expansion of video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) has reshaped thoracic surgical practice over the last two decades, offering reduced perioperative morbidity, shorter hospital stay, and oncological outcomes comparable to conventional thoracotomy in appropriately selected patients. Minimally invasive techniques now account for the majority of anatomical pulmonary resections in many high-volume centers and are being explored, in selected patients at experienced institutions, for increasingly complex procedures. This shift, however, raises a question that has received comparatively little attention: whether reduced trainee exposure to open thoracotomy may, over time, erode open thoracic surgical competence. As minimally invasive approaches become the institutional default, exposure to open surgery is declining, and the skills required to perform complex open resections or to manage intraoperative emergencies may become confined to a diminishing cohort of senior surgeons. In this narrative review, we examine the current boundaries of minimally invasive thoracic surgery, define the clinical scenarios in which open surgery remains indispensable\u2014including bronchoplastic and angioplastic resections, post-induction hostile surgical fields, and unplanned conversion\u2014and consider the implications of the ongoing paradigm shift for training, taking into account the substantial variability of thoracic surgical practice across different regions. We argue that open thoracic surgery is not an obsolete discipline but a foundational competence whose preservation may warrant deliberate attention through structured exposure, simulation, mentorship, and dedicated competence assessment. Throughout, we have sought to distinguish documented trends from reasonable concern and from speculative future risk, and we frame the central issue explicitly as a credible and foreseeable risk rather than a demonstrated decline.<\/jats:p>","DOI":"10.3390\/jcm15135135","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:41:38Z","timestamp":1782909698000},"page":"5135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Complex Thoracic Resections in the Minimally Invasive Era: Is Open Surgery Becoming a Lost Skill?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4032-9239","authenticated-orcid":false,"given":"Giacomo","family":"Argento","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Sapienza University of Rome Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erino Angelo","family":"Rendina","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sapienza University of Rome Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Maurizi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sapienza University of Rome Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/S1470-2045(16)00173-X","article-title":"Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: A randomised controlled trial","volume":"17","author":"Bendixen","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.athoracsur.2020.05.144","article-title":"Survival after thoracoscopic surgery or open lobectomy: Systematic review and meta-analysis","volume":"111","author":"Avanzas","year":"2021","journal-title":"Ann. 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