VATS

What is VATS?

Video-assisted thoracic surgery (VATS) is a common procedure to diagnose and treat certain conditions that affect your chest area. Thoracic refers to the thorax, the area between your neck and abdomen that includes multiple organs. For this minimally invasive surgery, healthcare providers insert a thin tube with a tiny video camera on the end (a thoracoscope) into a small incision between the ribs in your chest. This scope allows your provider to see inside your chest cavity.

Your provider inserts surgical instruments into separate small incisions. They use images from the thoracoscope to guide and perform procedures. You may also hear the term video-assisted thoracoscopy.

A thoracic (chest) or cardiothoracic (heart and chest) surgeon performs video-assisted thoracoscopy. These providers have additional training in performing surgery to diagnose and treat conditions in your chest area. They’re performing VAT surgical procedures more and more often because there are many advantages for you.

What does this procedure treat?

Healthcare providers mostly use VATS to diagnose and treat lung cancer or metastatic cancer that spreads to your lungs.

VAT procedures also help providers diagnose and treat other thoracic conditions, like:

• Cancer of the esophagus or thymus
• Metastatic cancer to the chest
• Pleural effusion and pleural mesothelioma
• Lung diseases like chronic obstructive pulmonary disease (COPD) and lung infections
• Pericardial effusion
• Spine tumors and paraspinal tumors
• Hyperhidrosis (excessive sweating)
• Myasthenia gravis
• Lymphoma

What are the types of video-assisted thoracic surgeries (VATS)?

In a hospital or surgical center, thoracic surgeons use VAT surgery to perform different procedures like:

• VATS lung resection, the removal of a small portion of your lung (wedge resection), a lobe of the lung (lobectomy) or your entire lung (pneumonectomy)
• Esophagectomy, the removal of your esophagus
• Thymectomy, the removal of a diseased thymus gland
• Decortication, the removal of infected material and scar from around your lung
• Lung volume reduction surgery (LVRS), the removal of diseased lung tissue

How should I prepare for this procedure?

You should follow your surgeon’s instructions on what to do before the procedure. They may need you to fast (not eat or drink) for several hours before VAT surgery. Your surgeon may ask you not to take certain medications, including vitamins and herbal supplements. You may also need to quit smoking.

Before video-assisted thoracoscopic surgery, you may get tests like:

• Blood tests, including a complete blood count (CBC)
• Heart tests like an electrocardiogram (EKG) or exercise stress test
• Imaging tests, like a chest X-ray, CT scan or positron emission tomography (PET) scan
• Pulmonary function testing
• Metabolic exercise stress test
• Upper endoscopy or gastrointestinal (GI) X-ray examination (barium swallow)

What happens during VATS?

You’ll receive general anesthesia to sleep through the procedure. You’ll lie on your nonsurgical side during surgery.

Depending on the thoracic condition and VATS procedure, your surgeon will:

1. Make several quarter-inch to half-inch incisions in your chest — for a uniport VATS (U-VATS) procedure, they make a single incision, instead
2. Insert the scope device, which sends images of the inside of your chest to a video screen
3. Insert surgical instruments into the other incisions
4. Use the video images to guide the removal of the diseased tissue or organ
5. Put in a temporary chest tube to drain air or fluids
6. Close the incisions with removable stitches or staples

Some surgeons use robotic technology to perform video-assisted thoracoscopy. Your surgeon views images from the thoracoscope and operates robotic arms. They place these arms through small incisions to remove tissue or the diseased organ.

A VATS or robotic procedure usually takes two to three hours for lung cancer operations. Times for video-assisted thoracoscopic surgeries vary based on how complex the operation is.

What are the potential benefits and risks of this procedure?

Minimally invasive surgery often takes less time to perform than an open-chest surgery (thoracotomy). Because there’s no large incision, the recovery is less painful and often quicker.

But it’s good to remember that you have vital organs in your chest, and any procedure involves some risk.

Benefits of VAT surgeries include:

• A shorter hospital stay
• Less severe postoperative pain and scarring
• Faster recovery of respiratory function
• Lower risk of infection
• A quicker return to daily activities

VAT surgical procedures have lower rates of complications than open procedures. But they carry a risk of complications like:

• Arrhythmias
• Blood clots and strokes
• Bruising
• Collapsed lung (pneumothorax) or atelectasis (lung air sacs don’t properly inflate)
• Damage to nearby glands, organs, nerves or blood vessels
• Hypoxemia (low blood oxygen)
• Infections
• Internal bleeding and blood loss
• Respiratory problems like pneumonia

What happens after video-assisted thoracoscopic surgery?

Your surgeon may send tissue to a lab for a biopsy. A pathologist examines the tissue for signs of cancer, infection or disease. The findings may indicate a need for additional surgery or treatments.

After surgery, your healthcare team will help you manage pain. They’ll also encourage you to do deep breathing exercises and walk around. Your healthcare provider may ask you to do physical therapy to help you recover faster and lower your chances of complications.

Before you go home, a provider will remove the chest tube they put in during VAT surgery.

What is the recovery time?

Recovery time varies depending on your VATS procedure. It may take two weeks to recover from some procedures and eight weeks for others. During this time, you’ll have follow-up appointments with your provider.

Most people need to spend one or two nights in the hospital after surgery. You should carefully follow your discharge instructions. Doing so will promote a healthy recovery and lower your risk of complications.

Your at-home recovery may include:

• Changing surgical dressings regularly
• Not driving and staying home from work or school for the designated time
• Not lifting anything heavy for a set time
• Taking antibiotics, pain relievers or other medications as directed by your provider
• Walking at least three times a day to prevent blood clots in your legs

Your outlook depends on the specific thoracic disorder, your overall health and the success of treatments. Your thoracic surgeon can discuss your prognosis (outlook) with you based on your diagnosis.

When should I call my healthcare provider?

You should call your provider if you experience:

• Chest pain
• Difficulty breathing
• Signs of infection, like redness or yellow discharge at the incision site or a fever

What is thoracoscopy vs. VATS?

VATS and thoracoscopy are the same thing. Surgeons use a thoracoscope to perform thoracoscopy/VATS.