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Video-Assisted Thoracoscopic Surgery

What is VATS?

Video-assisted thoracoscopic surgery (VATS) is a type of surgery for diagnosing and treating many conditions affecting the chest area (thorax). It is done using a thin tube with a tiny video camera at the end (thoracoscope). It's a type of minimally invasive surgery. That means it uses smaller cuts (incisions) than traditional open surgery (1 large incision). 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 and nose through a series of tubes. Through these tubes, the lungs bring oxygen into the body. And they 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. Often, 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 the tiny tube with the video camera and other small tools through these cuts. They 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 surgery method. Healthcare providers can use VATS to do many procedures that used to need traditional open surgery.

Why might I need VATS?

Healthcare providers use VATS for many different conditions affecting the thorax. These include lung and heart conditions. You might need VATS to remove a small part of the tissue if you have cancer (biopsy). 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 food pipe (esophagus).

Healthcare providers can use VATS to remove part or all of an organ. For example, your 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. This is often because of cancer.

Heart procedures may use VATS. These include atrial fibrillation ablation, pacemaker lead placement, and mitral valve repair.

Many other procedures also use VATS. These include:

  • Draining part of the lung (as in an infection)
  • Draining a pus-filled infection (abscess)
  • Draining fluid from around the heart (as in 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

What are the risks of VATS?

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

  • Air leak
  • Lung perforation (puncture)
  • Abnormal heart rhythms
  • Excess bleeding
  • Pneumothorax (a collection of air outside the lung but within the pleural cavity, the space around the lungs)
  • Collapse of part or all of a lung (atelectasis)
  • Pneumonia (lung infection)
  • Collection of 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 health 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.

How do I get ready for VATS?

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 medicines before the surgery, such as blood thinners. Talk with your healthcare provider about all the medicines you take, including over-the-counter medicines, herbs, and any supplements.
  • 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.
  • Follow all directions you are given for taking your medicines and not eating or drinking before your surgery.

Your healthcare provider might need tests to see how well your lungs are working. They 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 or MRI to get more detailed pictures of the lungs
  • PET scan 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 before the surgery.

What happens during VATS?

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

  • You will likely get antibiotics to help prevent infection.
  • You will be given general anesthesia before the surgery starts. This will make you sleep deeply and painlessly during the surgery. You won’t remember it afterward.
  • The surgery will take several hours.
  • Your surgeon will clean the area to be operated on with an antiseptic solution. They will then make several cuts over your chest wall.
  • The surgeon puts a thin tube with a tiny video camera (thoracoscope) through 1 of these incisions.
  • The surgeon puts other small tools through other small incisions, as needed to do the procedure.
  • Your surgeon will do the procedure that is needed. For instance, they may remove part or all of a lung or other organ.
  • 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 if the cancer has spread and how advanced it might be.
  • Once the procedure is done, the camera and other tools will be removed.
  • Your surgeon will surgically close the chest incisions. A bandage will be applied.

What happens after VATS?

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

  • When you wake up, you might feel sleepy or drowsy and confused at first. You might wake up a few 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. This is often short-term (temporary).
  • You will feel some soreness or pain. But you shouldn’t feel severe pain. Pain control is important. If you need it, you can ask for pain medicine.
  • You will likely have a chest tube to help collect fluid from your lungs. It will be removed before you leave the hospital.
  • You will use a device (spirometer) that encourages you to breathe deeply to prevent an infection from developing.
  • You may wear special compression stockings to help prevent blood clots.
  • You may 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 likely have your stitches or staples removed in a follow-up appointment. Keep all your follow-up appointments.
  • You may tire easily after the surgery. But you will slowly 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.
  • Don't lift 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 trouble breathing, any signs of infection, fever, swelling, or pain that is getting worse. A small amount of fluid leaking from your incision is normal. Tell your provider if there is excessive discharge or bleeding.

Next steps

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 you will get the results
  • Who to call after the test or procedure if you have questions or problems, including after office hours and on weekends and holidays.
  • How much you will have to pay for the test or procedure