It has been almost 20 years since the first reports of minimally invasive lobectomies appeared. Despite the tremendous amounts of research performed on VATS lobectomy showing its benefit over open thoracotomy, a mere 32% of all lobectomies are performed via this technique in the Society for Thoracic Surgeons database and only 6% in the Nationwide Inpatient Sample (1). So, why is it that in a recent review of clinical stage I lung cancers over 70% were still completed using open thoracotomy?(2). Advocates of an open approach still cite the ability to sample and perform a “more thorough” lymphadenectomy, the instability of the VATS platform and the lack of precision with the fissure-less-dissection VATS technique as reasons to maintain the status quo.