Video-Assisted Thoracoscopic Surgery (VATS)
Surgical procedures may be needed to diagnose or treat medical issues within
the thoracic region of the body (the chest). In many cases, surgeons will
have the option of using a traditional, open procedure or a minimal access
Although each surgical situation is unique, doctors typically prefer to
use a minimal access procedure if they deem this method will be as successful
as an open procedure. Minimal access procedures have been shown to reduce
the risk of complications, pain and discomfort and to shorten hospital
stays and recovery times.
Video-assisted thoracoscopic surgery (VATS) is a common minimal access
procedure used to perform surgery in the thoracic region. During VATS,
surgeons use tiny cameras inserted into small incisions in the chest in
order to see the area they need to treat. They also use additional small
incisions to introduce surgical instruments into the area where they are
needed to perform the surgical procedure. This eliminates the need for
large surgical incisions or spreading the rib cage to access the area
that needs to be treated.
When deciding if a patient is a candidate for VATS, the surgeon will take
into consideration the patient’s overall medical history and specific
medical condition requiring surgery, as well as the anticipated outcome
of performing the procedure using VATS vs. an open access method.
Types of Surgeries that May Use VATS
Most thoracic surgeries can be performed using the video-assisted thoracoscopic
surgical technique. The most common use of VATS is for surgical procedures
to treat lung cancer, but other procedures may include:
- Lung biopsies
- Lung cancer surgery (lobectomy, wedge resection, pneumonectomy)
- Lung volume reduction surgery
- Esophagus surgery (esophagectomy)
- Removal of the thymus gland (thymectomy)
- Removal of excess fluid from the chest (pleural effusion)
Benefits of VATS vs. Open Procedures
In comparison to traditional, open methods of performing the above surgeries
(thoracotomy), VATS offers these benefits:
- Less pain
- Reduced blood loss
- Lower risk of infection
- Fewer complications
- Smaller incision scars
- Faster recovery times
- Shorter hospital stays
- Quicker return to daily activities
Risks of VATS
All surgical procedures involve some risk, although VATS procedures have
been shown to reduce risks and complications in comparison to open access
procedures. Possible risks associated with undergoing video-assisted thoracoscopic
- air leak
- partial collapsed lung (atelectasis)
- temporary or permanent nerve damage
- complications from anesthesia
- blood clot
A person's risk for developing these complications depends upon their
age, the procedure performed and existing medical conditions.
How VATS Is Performed
During surgery, patients are placed under general anesthesia. Once the
patient is asleep, a breathing tube is inserted to provide oxygen to the
lungs during surgery. Three to four small incisions, about one inch wide,
are then made in the chest wall.
The surgeon inserts a small tube containing a tiny camera on the end (thoracoscope)
into the chest cavity through one of the incisions. The camera is used
to give the surgeon visibility into the area by displaying images of the
inside of the chest on a video monitor in the operating room. The surgeon
uses the other incisions to insert small surgical instruments to be used
to conduct the needed surgery.
In some cases, the surgeon will perform robot-assisted surgery. When this
is done, a robotic surgical system and camera are used to perform the
procedure, with the surgeon responsible for operating the robotic system.
What to Expect After Surgery
Following surgery, patients will typically stay in the hospital for a few
days, although the length of time will depend on the type of procedure
performed and the patient’s overall health. It is normal for patients
to be sore and experience some pain at the incision sites, but discomfort
should be relatively minimal. Patients will be encouraged to get up and
walk several times a day while in the hospital to promote healing.
While there is still a period of recovery required after undergoing a minimal
access procedure like VATS, the time period is usually shorter and the
risk of complications lower in comparison to traditional open procedures.
During the first few weeks after leaving the hospital, patients will gradually
begin to recover their strength. After a few weeks, patients will be able
to drive and return to normal activities. Many people undergoing VATS
can return to work and their regular routine about 3 – 4 weeks after surgery.