VATS vs Robotic vs Open Lung Surgery: Cost & Recovery

VATS vs Robotic vs Open Lung Surgery: Cost & Recovery

• Dr. Parveen Yadav
• Nov 14, 2025

If you or a loved one has just been told you need lung surgery, you are likely feeling overwhelmed. It’s a stressful diagnosis, and it’s followed by a confusing set of choices. You are probably hearing terms like "Open Thoracotomy," "VATS," and "Robotic Surgery," all while trying to process what this means for your health, your family, and your finances.

My name is Dr. Parveen Yadav. As a thoracic surgeon with over 18 years of experience, including specialized training in surgical oncology at AIIMS, New Delhi, and a fellowship in thoracic surgery at Tata Memorial Hospital, Mumbai, I have performed all three types of these operations. My goal with this guide is to cut through the confusion.

You have two big, immediate questions:

1. "What will my recovery really be like?"
2. "How much is this going to cost in India?"

Let's answer those questions with transparent, honest, and up-to-date information for 2025.

What Are We Comparing? A Simple Guide to the 3 Types of Lung Surgery

Before we talk about cost and recovery, let's quickly define what these procedures are. The goal for all three is often the same—to remove the cancerous part of the lung (a procedure called a lobectomy). The only thing that changes is the tool the surgeon uses to get there.

1. Open Thoracotomy (The "Traditional" Approach)

This is the surgery your parents or grandparents would have had. To reach the lung, the surgeon makes one long incision (often 15-20 cm) on the side of your chest. The most crucial part to understand is that this procedure requires the ribs to be manually spread apart with a retractor to give the surgeon space to work. This rib-spreading is the primary source of the significant post-operative pain and longer recovery associated with this surgery.

2. VATS (Video-Assisted Thoracoscopic Surgery)

This is the modern "keyhole" or "minimally invasive" standard. Instead of one large cut, the surgeon makes 3-4 small incisions (or "ports"), each just a few centimeters long. A tiny high-definition camera and long, rigid instruments are placed through these ports. The surgeon performs the entire operation by watching a 2D monitor.

The biggest benefit? The ribs are not spread. This directly translates to less pain, less tissue damage, and a much faster recovery.

3. RATS (Robotic-Assisted Thoracic Surgery)

This is the most advanced "keyhole" approach and an evolution of VATS. It uses 3-4 small incisions, just like VATS.

Here’s the difference: the surgeon sits at a nearby console, controlling a set of robotic arms. This system gives the surgeon two game-changing advantages over VATS:

1. Immersive 3D Vision: The surgeon sees a magnified, 3D high-definition view inside your chest, restoring the natural depth perception that is lost on a 2D VATS monitor.
2. "Wrested" Instruments: The robotic instruments have 360-degree articulation, like a human wrist, but with a greater range of motion. This allows for exact movements in tiny spaces, far beyond what the human hand or the rigid VATS "sticks" can do.

At-a-Glance: Comparing Open, VATS, and Robotic Surgery for Indian Patients

For many patients, seeing the data side-by-side is the most helpful. This table summarizes the key differences based on current data.

Feature	Open Thoracotomy	VATS (Keyhole)	RATS (Robotic)
Est. Procedure Cost (India)	₹2,70,000 - ₹5,95,000	₹1,60,000 - ₹3,20,000	₹7,50,000 - ₹12,50,000
Typical Hospital Stay	7 - 14 days	3 - 5 days	3 - 5 days
Typical Return to Work	4 - 6 weeks+ (~27 days)	2 - 3 weeks (~12.5 days)	2 - 3 weeks
Post-Operative Pain	Very High (due to rib spreading)	Low	Potentially Lowest
Intra-Op Blood Loss	High	Low	Lowest
Scarring	Large 15-20cm scar	Minimal (3-4 small scars)	Minimal (3-4 small scars)
Risk of "Conversion-to-Open"	N/A	Higher (6.6% - 11.0%)	Lowest (0.7% - 6.0%)
Lymph Node Dissection	Good	Good	Excellent (Superior Staging)
Long-Term Cancer Survival	Equivalent	Equivalent	Equivalent

The Big Question: A Detailed Look at Lung Surgery Cost in India (2025)

The table shows a huge cost difference. Let's break down why.

Why is Robotic Surgery the Most Expensive?

There is no ambiguity here: RATS is the most expensive option. This is not due to the surgeon's fee; it is due to the technology itself.

• Capital Cost: A da Vinci surgical robot costs the hospital millions of dollars to purchase.
• Maintenance: These are complex machines that require expensive annual maintenance contracts.
• Disposable Instruments: The high-tech, wristed instruments have a limited number of uses and are extremely expensive to replace. To give you a real-world example, data from Tata Memorial Hospital shows a single "Robotic Surgery Consumable for Thoracic Lobectomy" can cost the hospital ₹2,64,000.

These costs are passed on to the patient, making the upfront price of the procedure significantly higher.

The "Total Cost" vs. "Upfront Cost" Fallacy

This is the most important financial concept I discuss with my patients. Many people look at the table and see that Open Thoracotomy (starting at ₹2,70,000) looks cheaper than Robotic Surgery and sometimes VATS.

This is a dangerous oversimplification. You must look at the "Total Cost of Care."

An open surgery's lower procedure cost is often canceled out by its recovery cost.

• A Longer Hospital Stay: An open surgery patient stays in the hospital for 7-14 days. A VATS or RATS patient stays for 3-5 days. Those 4-10 extra days of room rent (at ₹6,000 - ₹8,000/day), medications, and nursing care add up quickly.
• Higher Complication Risk: Open surgery has a higher risk of complications like pneumonia. A few days in the ICU (at ₹15,000 - ₹25,000 per day) can make an "affordable" open surgery more expensive than a smooth robotic procedure.
• Lost Income: As the table shows, open surgery patients are out of work for an average of 27 days, compared to just 12.5 for VATS. That's two extra weeks of lost income.

The Takeaway: When you factor in the shorter hospital stay and faster return to work, VATS is often the most affordable and highest-value option for the patient.

The Patient Experience: A Real Recovery Timeline You Can Expect

This is what matters most to your quality of life. The difference in recovery is not small—it is profound.

Week 1: In the Hospital

• Open Surgery: This week is focused on pain management. Because the ribs were spread, pain is significant. You will likely have an epidural. Your hospital stay will be between 7 and 14 days.
• VATS & Robotic Surgery: The experience is night and day. Because the ribs are not spread, pain is dramatically lower. Most of my patients are encouraged to be out of bed and walk the same day of their surgery. Your hospital stay is typically 3 to 5 days. Some studies suggest RATS patients report the absolute lowest pain scores in the first 24-48 hours.

Weeks 2-4: At Home (Return to Work)

• Open Surgery: You are still in active recovery. Lifting anything heavy is forbidden. You will likely feel significant fatigue. The average return-to-work time is 27 days or more.
• VATS & Robotic Surgery: You are regaining your strength quickly. You can walk, climb stairs, and perform light activities. The average return-to-work time is just 12.5 days. For a family's primary earner, this two-week difference is life-changing.

Long-Term: Scarring & Chronic Pain

• Open Surgery: You will have a large 15-20 cm scar. More importantly, a number of patients go on to develop Chronic Post-Thoracotomy Pain (PTPS), a persistent aching or burning sensation along the scar that can last for months or even years.
• VATS & Robotic Surgery: You will have 3-4 small, minimal scars. The risk of chronic pain is significantly lower. Studies show patients who undergo minimally invasive surgery report a much better long-term quality of life, with less fatigue and pain.

Will My Indian Health Insurance Cover Robotic Surgery? (An Honest Answer)

This is the "black box" of Indian healthcare, and it causes families immense stress. You must be your own advocate here.

The Good News vs. The Hidden Traps

The good news is that the Insurance Regulatory and Development Authority of India (IRDAI) has mandated that insurers must cover "modern treatments," which includes robotic surgeries.

BUT... this does not mean they will pay the full amount. Insurers use three common "traps" to limit their payout:

1. The Sub-Limit Trap: Your policy might have a ₹10 Lakh sum insured, but if you read the fine print, it may have a "sub-limit" for robotic procedures of only ₹1 Lakh, or even 1% (₹10,000).
2. The "Technology Fee" Denial: The insurer may approve the "surgery" but then deny the specific "robotics fee" or "consumable charge" (like that ₹2,64,000 item ) by calling it a "non-medical" or "non-essential" expense.
3. The "Equivalent Costing" Trap: This is the most common. The insurer will state that they will only pay the "equivalent cost of a conventional (open) surgery". If your robotic bill is ₹8,00,000 and the open surgery cost is ₹3,00,000, they will pay ₹3,00,000, leaving you to pay the ₹5,00,000 difference.

Your 3-Question Action Plan

Do not schedule your surgery until you have written pre-authorization from your insurer. Call your TPA (Third-Party Administrator) and ask these three questions:

1. "Does my policy have a sub-limit for robotic-assisted surgery?"
2. "Do you cover robotic consumables and 'technology fees'?"
3. "Do you cover the full procedure cost, or do you only pay the equivalent cost of an open surgery?"

Getting these answers in writing before your admission is the most critical piece of financial advice I can give you.

The Clinical Decision: Is One Surgery "Better" for Lungs Cancer Treatment?

As your surgeon, my priority is curing your cancer. This is where the technical details matter.

The Most Important Fact: Cancer Survival is Equivalent

Let me put your biggest fear to rest. For early-stage lung cancer, high-quality studies show that Open, VATS, and Robotic surgery all have equivalent and excellent long-term cancer survival rates.

The choice is not about if we can cure cancer. The choice is about the path (the pain, recovery, and risk) we take to get that cure.

The Real 'Wins' for Robotic Surgery: Staging and Conversions

So, if survival is the same, why ever pay for the expensive robot? As a surgeon, RATS gives me two significant technical advantages, which translate into tangible patient benefits.

1. A More Accurate Cancer Staging:
2. The most crucial part of Lungs Cancer Treatment is removing the lymph nodes in the chest. This is how we "stage" the cancer and determine if you need chemotherapy after surgery. Most experts agree that RATS is superior to VATS at removing more lymph nodes from more stations.6 Why this matters to you: More nodes = More accurate staging. The robot may help me find a tiny, hidden spot of cancer in a lymph node that VATS might miss. This finding could change your entire post-operative treatment plan and is critical for your long-term health.
3. A Lower "Conversion to Open" Rate:
4. A "conversion" is when a surgeon starts a keyhole (VATS or RATS) procedure but encounters something unexpected (like heavy scarring or bleeding) and is forced to "convert" to a large open thoracotomy to finish the surgery safely. This is the worst-case scenario for recovery—you get the trauma of the open surgery plus the more extended time under anesthesia.
5. Studies show the conversion rate for RATS is significantly lower than for VATS. One extensive 2021 study found the conversion rate for VATS was 6.6%, while for RATS it was just 0.7%. The robot's 3D vision and wristed tools simply allow surgeons to handle more complex challenges through a keyhole.

How to Choose? The Factor That Matters More Than the Machine

You've seen the data. VATS offers incredible value. RATS offers the pinnacle of technology. Open surgery is the proven, traditional method.

So, what should you choose?

My honest advice is this: The expertise of your surgeon is more important than the tool in their hand.

I have seen this my entire career. An expert, high-volume VATS surgeon will always get a better, safer result than a novice surgeon using a robot for the first time. The robot does not do the surgery; I do the surgery. The robot is a tool that enhances my skills.

The ideal scenario is to find a surgeon who is an expert in all three techniques. This ensures their recommendation is based 100% on your specific tumor, your anatomy, and your needs—not on the only procedure they know how to do.

Key Questions to Ask Your Thoracic Surgeon

When you go for your consultation (or second opinion), you are empowered with this information. Ask your surgeon these direct questions :

1. How many lobectomies do you perform each year?
2. Are you trained and credentialed in both VATS and Robotic surgery?
3. For my specific cancer, why are you recommending this one approach over the others?
4. What are your personal complication rates and, specifically, your conversion-to-open rate for this procedure?

My Final Takeaway as a Thoracic Surgeon

There is no single "best" surgery. There is only the best surgery for you.

• For most early-stage, straightforward lung cancers, VATS is the "gold standard." It provides all the advantages of minimally invasive surgery at an excellent and affordable "value".
• For more complex tumors (e.g., in a problematic location) or when a highly precise lymph node dissection is critical for staging, Robotic-Assisted Surgery (RATS) offers tangible, data-backed clinical advantages.
• For very large, advanced, or invasive tumors, Open Thoracotomy remains a powerful and necessary tool to ensure the entire cancer is safely removed.

If you or a loved one is facing a lung surgery diagnosis and are seeking a clear, comprehensive second opinion, I am here to help. Please contact my office in Delhi or Gurgaon. We will sit down together, review your scans, and create a clear, personalized plan to get you through this.