Video-assisted thoracoscopic surgery (VATS) is a form of key hole surgery that helps doctors to see inside the chest and lungs.

What do you understand by video-assisted thoracoscopic surgery?

Video-assisted thoracoscopic surgery, also known as VATS, is a type of 'keyhole' surgery where only very small incisions (cuts) are made to the body. VATS utilizes a fibreoptic scope known as a thoracoscope, which is a thin, tube-like instrument which has a camera built into the end. The camera feeds pictures from the chest on to a screen and allows the surgeon to look inside the chest and lungs. VATS can be used to do a wide range of things, including take biopsies (small samples of tissue) from the lungs. These samples can then be examined in the laboratory.

How is the procedure done?

The surgeon makes two or three small incisions or ports in the chest wall near the ribs. These small incisions are about two cm long. The surgeon then inserts the thoracoscope through one hole. The camera in the thoracoscope feeds video images to a computer screen, allowing the surgeon to see inside the chest. Usually he/she will also insert special surgical instruments into the other incisions. These instruments can be used to remove tissue which may have been seen on an X-ray, or fluid found in the chest. Once the surgery has finished, the instruments are removed and the incisions are closed, usually with stitches.

What is the use of VATS?

VATS is used for many different procedures including:

  • Taking biopsies from the lung or the lining of the chest.
  • Removing lymph nodes.
  • Removing lumps or growths from the lung.
  • To treat various lung conditions such as pleural effusion (where fluid accumulates in the lining of the lung).

How is video-assisted thoracoscopic surgery conducted?

VATS is carried out in the operating theatre. Before the procedure, a small needle will be placed in a vein to give you fluids and medications. It is usually done using a general anaesthetic which means you will be asleep for the surgery. You may also have an epidural. An epidural is a form of pain relief given through a thin tube placed into your back. Once you are asleep you may have a catheter put into your bladder. This is a thin, flexible tube that is inserted into your urethra (the hole through which you urinate) and then advanced into your bladder. This is because the epidural will make it difficult to urinate by you. It also allows doctors to measure how much urine you are making.

You will be placed on the operating table on your side. Your surgeon will make the incisions in your chest and insert the thoracoscope and any other instruments that are needed. After the surgeon has finished the surgery he/she will insert some small tubes into the chest. These are known as 'chest drains' and allow any fluid or air that collects to leak out. Any samples of tissue taken from your chest or lungs will be sent to the laboratory for further testing.

You will slowly be allowed to come round from the anaesthetic. Usually you are given oxygen through a mask. After a while you will be taken back to the ward to rest. The epidural usually stays in until the chest drains are taken out and you are able to take pain relief tablets.

Occasionally, although it was planned to use VATS, it is not possible to carry out your operation using keyhole surgery. This means another technique may need to be used. Your doctor should discuss this with you before the procedure.

How does the patient prepare for video-assisted thoracoscopic surgery?

Generally, if you smoke you may be asked to stop before the surgery, as this reduces the chance of breathing problems. If you take anticoagulants ('blood thinning' medicines) you may need to stop these for a few days before the surgery. Your doctor should discuss this with you. You may also have some special tests of your lungs to see how well they are working (see separate leaflet called Spirometry' for more details). If you are to have a general anaesthetic you will be asked not to eat or drink for a certain length of time before the procedure. Your local hospital will give you information on this.

What happens after video-assisted thoracoscopic surgery?

You will generally stay in hospital for between 3-5 days after the surgery. However, this is a rough guide and will depend on the speed of your recovery. Your surgeon will discuss your progress with you and advise you on how long you should stay. You may be seen by the physiotherapist who may give you some breathing exercises to help prevent infection.
You should not expect to be back to full mobility immediately after the operation. Although VATS is a 'keyhole' procedure, the camera and instruments have to pass between the ribs. Sometimes they can press against the nerves which also lie here. This may cause some pain or numbness in the area of the incisions. If this does not go away you should contact your doctor or specialist nurse for advice. You will usually be discharged from hospital with a supply of painkillers but it is important you contact your doctor for additional supplies.

What are the possible side effects?

It is usually easier for patients to recover from VATS compared with normal chest surgery (often called 'open' surgery) because the wounds from the incisions are much smaller. Air leaks from the lung that don't heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. A very small number of patients have significant bleeding requiring a transfusion or larger operation. It is also possible, although not common, to develop an infection of the wound site or of the lung itself.

You should contact your doctor if you become unwell after having VATS. In particular, if you have any of the following problems: fever, chest pain, coughing up blood, shortness of breath, the wound sites become red or look to have pus draining.

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