and patients generally require a 7- to 10-day hospital stay before their pain is adequately controlled with oral opioid analgesics that they can take at home. A great deal of emphasis is placed on post-operative pulmonary toilet because the incisional pain associated with thoracotomy leads to a decreased ability of patients to cough and clear bronchial secretions, which in turn leads to an increased risk of persistent atelectasis (collapsed areas of lung) or pneumonia. Finally, to allow time for the divided muscles and bone fractures to heal, patients must refrain from strenuous activity or lifting greater than 5 lbs for 6 weeks after surgery. History Video-assisted thoracoscopic surgery, or VATS, came into widespread use in the 1990s and early on in its development practitioners began to perform lobectomy via VATS incisions. The advantage of VATS over thoracotomy is that major chest wall muscles are not divided and ribs are not spread. This leads to reductions in the intensity and duration of post-operative pain and allows patients to return to full activity more quickly. For lung cancer VATS lobectomy is the same as lobectomy performed via thoracotomy in that the pulmonary artery, pulmonary vein, and bronchus to the involved pulmonary lobe are individually dissected, ligated and divided. Generally, endoscopic stapling devices are used to ligate and divide the vessels and the bronchus however conventional suture material can also be used. During VATS lobectomy, the structures being operated on are not directly visualized with the naked eye but are visualized solely with a rigid thoracoscope. A camera attached to the thoracoscope transmits the image to a video screen, which allows surgeons and assistants to observe the flow of the operation. Surgical specimens are placed into a water-tight bag and removed from the chest without morcellization (i.e. breaking up the specimen into small pieces before removal); this prevents seeding of the VATS incisions with tumor cells and allows for an intact specimen for pathology examination and cancer staging. Removal of lymph nodes from the mediastinum is not compromised by VATS and remains a cornerstone of the surgical therapy of lung cancer. Visualization is enhanced due to the magnification afforded by the fiberoptic thoracoscope and a 30-degree angle of visualization aids in looking around corners. However, because the incisions are too small to allow passage of the surgeon's hands into the thorax, the surgeon's tactile input is compromised. VATS operations rely on a thorough