Video-Assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) is a type of surgery for diagnosing and treating a variety of conditions involving the chest area (thorax). It uses a special video camera called a thoracoscope. It is a type of minimally invasive surgery. That means it uses smaller cuts (incisions) than traditional open surgery. One common reason to do VATS is to remove part of a lung because of cancer.

You have 2 lungs: a right lung and a left lung. These lungs connect to your mouth through a series of tubes. Through these tubes, the lungs bring oxygen into the body and remove carbon dioxide from the body. Oxygen is needed for all functions of your body. Carbon dioxide is a waste product that your body needs to get rid of. Most people can get by with having part of a lung removed, if needed. Usually, the remaining lung tissue can provide enough oxygen and remove enough carbon dioxide.

During VATS, your surgeon makes several small cuts on the chest wall. The provider puts a special camera and other small tools through these cuts. He or she might use these tools to remove part of the lung, drain fluid from the lung, or do a procedure on the heart or other region.

You may recover more quickly after VATS than with the traditional open approach. Healthcare providers can use VATS to do many procedures that used to need traditional open surgery.

Healthcare providers use VATS for a wide variety of conditions involving the thorax. These include conditions of the lung and heart. You might need it to remove a small portion of tissue if you have cancer. Your healthcare provider might use VATS to biopsy part of the lung, the lymph nodes, the tissue around the lung, the tissue around the heart, or the esophagus.

Healthcare providers can use VATS to completely remove part or all of an organ. For example, your healthcare provider might need to remove part or all of a lung because of traumatic injury, infection, or cancer. VATS is also used to remove part or all of the esophagus or the thymus, often because of cancer.

Procedures on the heart may use VATS. These include atrial fibrillation ablation, pacemaker lead placement, and repair to the mitral valve.

A number of other procedures also use VATS. These include:

• Draining part of the lung (as in an infection)
• Draining an abscess
• Draining fluid from around the heart (as in an infection or inflammation)
• Removing restrictive fibrous tissue over the lung
• Doing surgery to prevent repeated pleural effusions
• Treating gastroesophageal disease with surgery
• Fixing congenital problems of the chest wall
• Treating paralysis or hernia of the diaphragm

Many people who have VATS do very well. But there are some possible complications. Some of these are:

• Air leak
• Partial collapsed lung (atelectasis)
• Abnormal heart rhythms
• Excess bleeding
• Pneumonia
• Collection of thick pus in the chest cavity (empyema)
• Wound infection
• Blood clot. This can lead to pulmonary embolism or stroke.
• Shock
• Complications from anesthesia

Your age, other medical conditions you have, and the reason for your VATS will help determine your risk for different complications. Before your surgery, ask your healthcare provider about your specific risks.

Ask your healthcare provider about what you need to do to get ready for your VATS. In general:

• You may need to stop taking certain medicine before the surgery, like blood thinners. Talk with your healthcare provider about all the medicines you take, including over-the-counter medicines.
• If you smoke, you need to quit before your surgery. Ask your healthcare provider for resources to help you.
• Daily exercise is an important part of getting ready. Ask your healthcare provider what kind is best for you.
• You might need to do breathing exercises with a device called a spirometer.
• Avoid eating or drinking anything after midnight before your surgery.

Your healthcare provider might need tests to see how well your lungs are working. He or she may also want to check your overall health before your surgery. These will depend somewhat on the reason for your VATS. Some of these might include:

• Chest X-ray to see the heart and lungs
• Chest CT scan to get more detailed pictures of the lungs
• Positron emission tomography to look for cancer tissue
• Electrocardiogram to check the heart rhythm
• Pulmonary function tests to see how well your lungs are working
• Blood tests to check overall health

Any hair over the surgical area may be removed with clippers before the surgery.

Ask your healthcare provider about what to expect during your VATS. In general:

• You will probably get antibiotics to help prevent infection.
• You will be given anesthesia before the surgery starts. It will cause you to sleep deeply and painlessly during the operation. You won’t remember it afterward.
• The operation will take several hours.
• Your surgeon makes several cuts over your chest wall.
• The surgeon puts a small video camera (thoracoscope) through one of these incisions.
• The surgeon puts other small instruments through other small incisions as needed to do the procedure.
• Your surgeon does the procedure. For example, he or she may remove part of a lung.
• If you need to have part of your lung removed because of cancer, your surgeon might take out some lymph nodes as well. These can help show how advanced a cancer might be.
• Once the procedure has been completed, the camera and other instruments will be removed.
• Your surgeon will surgically close the chest incisions. A bandage will be applied.

Ask your healthcare provider about what to expect after your VATS. In general:

• When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
• You will be hooked up to several machines so the medical staff can carefully watch your heart rate and other vital signs.
• You may get oxygen through small tubes placed in your nose. It’s usually temporary.
• You will feel some soreness. But you shouldn’t feel severe pain. If you need it, you can ask for pain medicine.
• You will probably have a chest tube to help collect fluid from your lungs.
• You will use a device that encourages you to breathe deeply to prevent an infection from developing.
• You may wear special stockings to help prevent blood clots.
• You will need to stay in the hospital for a few days.

After you leave the hospital:

• Make sure you have someone to drive you home. You will also need some help at home for a while.
• You will probably have your stitches or staples removed in a follow-up appointment. Be sure to keep all your follow-up appointments.
• You may tire easily after the surgery. But you will gradually start to recover your strength. It may be several weeks before you fully recover.
• You need to be up and walking several times a day.
• Ask your healthcare provider when it will be safe for you to drive.
• Avoid lifting anything heavy for several weeks.
• Follow all the instructions your healthcare provider gives you for medicine, exercise, diet, and wound care.
• Call your healthcare provider right away if you have any signs of infection, fever, swelling, or pain that is getting worse. A small amount of drainage from your incision is normal.

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure