Video-assisted thoracic surgery (VATS)

Overview

Video-Assisted Thoracic Surgery (VATS) is a minimally invasive technique used to diagnose and treat various chest conditions. During the procedure, a thin tube with a small video camera, called a thoracoscope, is inserted through a small incision in the chest. This allows doctors to see inside the chest cavity. Additional small incisions are made to insert surgical tools, and the images captured by the thoracoscope help guide the surgery. This procedure is also known as video-assisted thoracoscopy. 

The term “thoracic” refers to the area between the neck and abdomen, which includes blood vessels, lymph nodes, and other structures.

• The breastbone, thoracic spine, and ribs.
• Thymus gland, an immune system component.
• Esophagus.
• Lungs.
• Diaphragm.
• The pericardium, or sac that surrounds your heart, and your heart.

Video-assisted thoracoscopy is carried out by thoracic (chest) or cardiothoracic (heart and chest) surgeons. These medical professionals have had additional training in surgery to detect and treat diseases pertaining to the chest region.

Types of VATS

Thoracic surgeons can execute a variety of procedures with VATS, including:

• Esophagectomy: a surgical procedure to remove the esophagus.  
• Laminectomy: used to treat spinal tumors and abscesses.  
• Lung volume reduction surgery (LVRS): involves removing damaged lung tissue.  
• Pericardiectomy: the partial or complete removal of the pericardium, the membrane surrounding the heart.  
• Thymectomy: a surgery to remove the diseased thymus gland. when it is diseased.  
• VATS lobectomy: the removal of a cancerous lobe of the lung using video-assisted thoracic surgery.

Reasons for undergoing the procedure

VATS is primarily used by doctors to identify and treat lung cancer or cancer that has metastasized to the lungs.

Moreover, VATS aids in the diagnosis and management of additional thoracic disorders such as: 

• Esophageal cancer.
• Heart cancer.
• Pericarditis.
• Lung infections such as tuberculosis and lung disorders such as Chronic Obstructive Pulmonary Disease (COPD).
• Pleural effusion and pleural mesothelioma.
• Thymoma and thymic carcinoma.
• Hiatal hernia.
• Hyperhidrosis (excessive sweating).
• Myasthenia gravis.
• Spine tumors and abscesses.

Risks

There is a chance that VATS will cause issues like:

• Infections.
• Arrhythmias.
• Bruising.
• Blood clots and strokes.
• Injury to blood vessels, nerves, glands, or organs in the vicinity.
• Pneumothorax (collapsed lung) or atelectasis (improper inflation of the lung air sacs).
• Respiratory issues, such as pneumonia.
• Hypoxemia (low blood oxygen).
• Loss of blood and internal hemorrhage.

Before the procedure

You should adhere to the pre-procedural guidelines provided by your surgeon. Before surgery, you might need to fast—that is, not eat or drink anything—for a specific amount of time. You could be asked by your surgeon to refrain from taking specific medications, such as herbal supplements and vitamins. You might also have to give up smoking.

You could have tests like these prior to surgery:

• Blood work, including a complete blood count (CBC).  
• Cardiac tests, such as an electrocardiogram (EKG) or an exercise stress test.  
• Imaging studies, such as chest X-rays, CT scans, or Positron Emission Tomography (PET) scans.  
• Pulmonary function tests to assess lung capacity.  
• Upper endoscopy or a gastrointestinal X-ray with a barium swallow.  

During the procedure

VATS is performed in a surgical facility or hospital. To put you to sleep during the process, general anesthesia is administered. During the procedure, you will lie on your nonsurgical side.

Based on the VATS technique and thoracic condition, your surgeon:

• Makes many incisions in your chest that range from a quarter to a half inch. Alternatively, they do a uniport VATS (U-VATS) surgery with a single incision.
• Inserts the scope equipment, which projects images of your chest’s inside onto a video screen.
• Inserts surgical tools through the additional incisions.
• Makes use of the video images to direct the removal of the diseased tissue or organ. 
• Uses staples or removable stitches to seal the incisions.

After the procedure

For a biopsy, your surgeon might send tissue to a lab. The doctor looks for indications of illness, infection, or malignancy in the tissue. The results can point to the necessity for more surgery or medical interventions.

Outcome

After surgery, the majority of patients must stay in the hospital for a few nights. It is important that you closely adhere to your discharge guidelines. By doing this, you’ll encourage a speedy recovery and reduce the likelihood of problems.

Your healing at home could consist of:

• Regularly changing surgical dressings.
• Avoiding driving and staying home from work or school for a specified period.
• Taking a period of time to rest and avoid excessive lifting.
• Following your doctor’s instructions when taking antibiotics, painkillers, or other prescription drugs.

Your prognosis is dependent upon the particular thoracic condition, general health, and treatment outcomes. Based on your particular diagnosis, your thoracic surgeon can talk to you about your prognosis.