Video-assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) is a surgical procedure that allows doctors to see inside the chest and lungs. It is a form of ‘keyhole’ surgery which can be used to do a number of different surgical procedures.

Understanding video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery (VATS) is a surgical procedure used in the chest and lungs. It is a type of ‘keyhole’ surgery where only very small cuts (incisions) are made to the body. VATS uses a special instrument called a thoracoscope. This 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. This allows your surgeon to look inside the chest and lungs. VATS can be used to do a wide range of things, including take small samples of tissues (biopsies) from the lungs. These samples can then be examined in the laboratory.

Video-assisted thoracoscopic surgery – the process

The surgeon makes two or three small cuts (incisions) in the chest wall near the ribs. These holes are known as ports and are usually 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.

Use of video-assisted thoracoscopic surgery

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 fluid accumulating in the lining of the lung (pleural effusion).

During video-assisted thoracoscopic surgery

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 the hole through which you urinate (your urethra) and then advanced into your bladder. This is because the epidural will make it difficult to urinate by yourself. 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 cuts (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.

Getting prepared for video-assisted thoracoscopic surgery

Generally, if you smoke you it will be wise to stop it before surgery as it reduces chances of complications. If you are taking any blod thinning medicines (Anticoagulants) you would be asked to stop it few days before surgery depending on the type of blood thinner you are taking. You may also have some special tests of your lungs to see how well they are working. 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.

Post video-assisted thoracoscopic surgery care

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.

Possible side-effects or challenges

It is usually easier for patients to recover from VATS compared with normal chest surgery (often called ‘open’ surgery) because the wounds from the cuts (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: high temperature (fever), chest pain, coughing up blood, shortness of breath, or the wound sites becoming red or looking to have pus draining.​