From Pleural Drainage to Artificial Intelligence: Selected Historical Milestones and Visionary Pioneers Shaping Innovation in Thoracic Surgery

Thoracic surgery evolved from procedures aimed at controlling pleural infection and tuberculosis into a technologically advanced specialty integrating oncologic resection, airway and chest wall reconstruction, transplantation, minimally invasive surgery, robotics, and data-driven care. This deliberately selective narrative historical review examines selected turning points that changed the scope or practice of the specialty and the representative pioneers associated with them. A targeted literature search prioritized original landmark reports together with contemporary evidence. The trajectory begins with drainage, collapse therapy, and solutions to open pneumothorax; continues through pneumonectomy, bronchoplastic and sublobar resection, mesothelioma surgery, pulmonary metastasectomy, screening, tracheal reconstruction, lung autotransplantation, and transplantation; and extends to VATS, uniportal and non-intubated surgery, RATS, enhanced recovery, and artificial intelligence. Across these eras, innovation repeatedly shifted from radicality toward preservation and from isolated operative technique toward multidisciplinary perioperative systems. Randomized trials have also shown that progress may require reassessing or abandoning previously accepted surgical paradigms. Thoracic surgery is therefore best understood not as a chronology of operations, but as a continuing process of redefining what is technically possible, oncologically appropriate, physiologically tolerable, and clinically valuable.