Video-Assisted Thoracoscopic Surgery Procedure
Overview
Video-assisted thoracoscopic surgery (VATS) is a type of minimally invasive surgery for procedures inside the chest. Instead of making a large incision, surgeons make small cuts and use a thoracoscope, a thin tube with a camera. The camera displays detailed images on a screen, guiding the surgeon throughout the operation.
Key Features:
- Uses small incisions between the ribs.
- Minimizes damage to surrounding tissue.
- Allows for quicker recovery compared to open thoracic surgery.
Reasons for the Procedure
Doctors use video-assisted thoracoscopic surgery (VATS) to diagnose and treat a variety of chest and lung conditions. One of its main applications is managing lung cancer, particularly in its early stages. Surgeons may use VATS to remove tissue samples or abnormal growths, such as those associated with pleural mesothelioma. VATS is also useful for:
- Lung procedures like lung volume reduction or removing trapped air or fluid around the lungs.
- Treating excessive sweating (hyperhidrosis) when other treatments are ineffective.
- Esophageal conditions, including removal of part of the esophagus or repair of a hiatal hernia.
- Other thoracic surgeries, such as removing the thymus gland or performing repairs involving the heart, diaphragm, ribs, or spine.
This minimally invasive approach allows for diagnosis and treatment while reducing recovery time and surgical risks compared to traditional open chest surgery.
Risks
Possible risks and complications related to VATS include:
| Complication | Description |
|---|---|
| Pneumothorax | Lung collapse due to air leak |
| Air Leak | Continued air release after surgery |
| Lung Perforation | Accidental lung puncture |
| Pneumonia | Lung infection |
| Empyema | Pus buildup around the lung |
| Bleeding | Abnormal bleeding at or near the operation site |
| Nerve Damage | Damage to nerves near the chest |
| Post-Op Pain | Discomfort at the incision or instrument sites |
- Pneumothorax: Air can leak into the space around the lung, causing it to collapse.
- Air Leak: Sometimes, air continues to leak from the lung after surgery.
- Lung Perforation: The lung tissue may get accidentally punctured.
- Pneumonia: Infection in the lung can occur after the procedure.
- Bleeding: Excess bleeding might happen during or after the surgery.
- Empyema: Pus may collect in the space around the lungs.
- Nerve Damage: Short-term or lasting nerve injury is possible.
- Rib Spreading & Post-Operative Pain: Some discomfort or pain may happen where instruments were inserted.
Getting Ready for the Procedure
Preparation for video-assisted thoracoscopic surgery (VATS) includes blood tests, chest X-rays, lung function tests, and possibly a heart evaluation. Patients also receive instructions on fasting and managing medications before surgery. Since VATS is performed under general anesthesia, it is important to follow all preoperative guidelines to ensure safety.
What to Expect During the Procedure
The surgical team administers general anesthesia and inserts a breathing tube. Then, they make a few small openings in the chest wall to insert a camera and slender surgical instruments. Depending on the condition, surgeons may perform procedures such as a pleural biopsy or remove mediastinal masses.
After surgery, a chest tube is usually placed to drain air or fluid from the pleural space. Most patients stay in the hospital for a few days—typically shorter than after traditional open-chest surgery. Recovery time varies depending on the condition being treated.
Study Findings
Surgeons using video-assisted thoracoscopic surgery (VATS) improved outcomes compared to open chest surgery for lung and chest conditions. Most patients experienced less pain after VATS, along with lower rates of complications and shorter hospital stays. Recovery times were also faster, allowing patients to return to their normal activities more quickly.
Lung Operations Compared
| Procedure | Conversion Rate | Mortality | Recurrence Rate | Notes |
|---|---|---|---|---|
| VATS Lobectomy | 11% | 1.8% | — | Similar survival to open lobectomy |
| VATS for Spontaneous Pneumothorax | — | — | 4.6% | Lower recurrence with pleurodesis |
Surgeons used VATS for a variety of chest surgeries, including:
- Lobectomy for early-stage lung cancer.
- Wedge resection is a surgical procedure designed to remove small sections of lung tissue.
- Pleurodesis to keep the lung expanded and reduce recurrence of a collapsed lung.
- Sympathectomy for treating excessive sweating (hyperhidrosis).
- Lung volume reduction surgery for certain chronic lung diseases.
Surgeons sometimes removed fewer lymph nodes during VATS compared to open surgery, but long-term results in treating cancer were similar. Recurrence after VATS for spontaneous pneumothorax was lower when pleurodesis was also performed. Patients generally saw better function within weeks after VATS compared to traditional surgery.
