Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery. Thoracotomy Anatomic lung resection, i.e. pulmonary lobectomy or pneumonectomy, in conjunction with removal of the lymph nodes from the mediastinum is the treatment modality that provides the greatest chance of long-term survival in patients with early stage non-small cell lung cancer. Anatomic lung resections require a dissection of the pulmonary hilum with individual ligation and division of the pulmonary artery, pulmonary vein, and the bronchus where these enter the lung. In the setting of lung cancer, the rationale for anatomic lung resection is a complete removal of a lung tumor along with the lymphatics that drain that tumor to assure that any tumor cells present in the lymphatics will also be removed; lesser resections have been shown to be associated with a higher risk of local recurrence and diminished long-term survival. A cornerstone of surgical treatment of early stage lung cancer is aggressive removal of lymph nodes from the mediastinum; this enhances the likelihood of removing all cancer cells (complete resection) and identifies patients who will require additional treatment (i.e. adjuvant chemotherapy). An important consideration when performing anatomic lung resection is to spare as much lung tissue as possible; while lobectomy and pneumonectomy are equivalent cancer operations, the risk of complications and morbidity is considerably less with lobectomy. Traditionally, pulmonary lobectomy is performed through a poster-lateral thoracotomy incision; over decades, thoracotomy has demonstrated its effectiveness in providing access to structures in the thorax and is in general tolerated by patients. Thoracotomy, as most commonly performed, requires cutting through one or more major muscles of the chest wall including the latissimus dorsi, pectoralis or serratus muscles, and spreading of the ribs with a rib spreader. Because the joints of the ribs with the vertebral bodies have only limited flexibility, the use of a rib spreader usually results in rib fracture in the process of rendering the interspace between the ribs wide enough to perform a pulmonary lobectomy. Because of this, thoracic surgeons generally intentionally remove a section of one or more ribs in an effort to prevent splintered rib fracture associated with the use of the rib spreader. There is wide consensus that thoracotomy is one of the most painful incisions that patients can undergo. In the initial post-operative setting after thoracotomy, the use of epidural catheters, patient-controlled analgesia pumps for intravenous narcotic administration, and intravenous ketorolac are commonplace