Video-assisted thoracoscopic surgery (VATS)

Video-assisted thoracoscopic surgery (VATS) is performed to diagnose and treat various conditions inside the chest area. The area of surgery can include the lungs, heart, and the space around the lungs called the pleural cavity. The surgery is minimally invasive and beneficial than the traditional open surgery due to:

• Smaller cuts
• Lesser hospital stay
• Reduced post-surgical pain 
• Faster recovery

For the procedure, a special device with a camera, called a thoracoscope, will be inserted through an incision (cut) in your chest. Thoracoscope helps to visualize the area inside the chest. Depending on the condition to be treated, the surgeon may further use various tools to remove a tissue sample, drain fluid from the lung, or remove a part of the lung during the surgery.

This surgery may be performed to:

• Remove a tissue sample for biopsy test 
• Diagnose and treat lung cancer 
• Treat pneumothorax or collapsed lung 
• Remove a diseased part of a lung or lungs
• Diagnose lung infections and conditions associated with the thymus gland
• Detect the stage of cancer 
• Remove fluid from the pleural cavity 
• Drain fluid from the heart muscles 
• Remove pus (a fluid that contains bacteria and dead white blood cells)
• Treat diseases of the digestive system 
• Fix any birth defect inside the chest wall

This surgery is contraindicated in individuals with the following conditions:

• Severe chronic obstructive pulmonary disease
• Bleeding disorder
• Major hypoxia (lack of oxygen)
• Those who have a central or large tumour
• Haemodynamic instability (a condition that occurs due to abnormal or unstable blood pressure, leading to inadequate supply of blood to the organs)
• Pulmonary hypertension (severe blood pressure that affects the blood vessels in your heart and lungs)
• Severe adhesions (fibrous tissue formation) in the pleural cavity
• Inability to tolerate lung isolation (making a lung function independently of the other during surgery)
• Intraluminal airway mass

You will need the following preparations before this procedure:

• Your healthcare provider will perform a physical examination and order a few diagnostic tests such as:
  • Chest X-ray (to see the health of your lungs and heart)
  • Positron emission tomography (to detect cancer tissue)
  • Blood tests (to check your overall health for the surgery)
  • Electrocardiogram (to check heartbeats) 
  • Pulmonary function tests (a breathing test)
  • Methicillin-resistant Staphylococcus aureus (MRSA) screening test (to check for the presence of MRSA bacteria) 
  • Quantiferon blood test (to check for the presence of tuberculosis)
• Tell your doctor about all the medicines (over-the-counter or prescription), herbs, and supplements that you take. Your doctor may ask you to discontinue blood thinners like aspirin, warfarin, or clopidogrel before the surgery.
• You will have to fast from midnight before the surgery.
• Your doctor will suggest you to quit smoking and reduce the intake of alcohol before the surgery.
• You will have to sign an approval form if you agree to the procedure.
• Make sure to arrange for a family member or friend to take you to the hospital and bring you back home after the surgery.

After the admission procedure, the hospital staff will provide you with a hospital gown. You will be asked to lie on your back over the operation table and an intravenous (IV) catheter will be inserted in your arm or hand through which you will receive medicines and fluids during the surgery. General anaesthesia (a medication to keep you relaxed and pain-free during the surgery) will be administered to you.

In the operation theatre, the following steps are performed:

• You will be positioned on your side with your arm above your head.
• The surgeon will make various small incisions on your chest wall and insert a thoracoscope through one of these cuts to look for the presence of a condition in your chest cavity. 
• He/she will insert more instruments in your chest cavity through the other cuts as required to perform the surgery. For example, in the case of cancer in any area of your chest, you could have the affected part removed during this procedure. 
• Once the condition is operated, the surgeon will remove all the tools, including the thoracoscope. 
• If needed, a chest tube will be placed in to remove air or fluid from the lung cavity. 
• Finally, the surgeon will close the cuts with staples or sutures, and use a bandage to cover them.

The duration of the surgery may vary based on your condition. Generally, it takes about one to two hours. The hospital staff will shift you to the recovery area after the surgery. You will be given an oxygen mask for quick recovery from the anaesthesia. A nurse will check your vital signs like pulse and blood pressure continuously. You may also receive painkillers to reduce your pain after the surgery.

You will be given a liquid diet through an IV until you can eat and drink as normal. You will be taught breathing exercises during your hospital stay. Your drainage tube will be removed a day before your discharge. Your hospital stay may last for three to five days. However, this may vary based on the speed of your recovery.

Once you reach home, you will need to take the following care:

• Wound care: 
  • Keep your wound clean and dry.
  • Avoid applying powder, cream, or deodorant on the operated area.
  • Showering/bathing is allowed after the surgery. However, prefer to take a shower for the first two weeks.
  • Avoid soaking in a bathtub for at least six weeks following the procedure.
• Pain management: The surgeon may prescribe pain medicines to relieve your pain after VATS, which should be taken as directed.
• Diet: 
  • You must drink one to two litres of fluid daily.
  • Eat a well-balanced diet.
• Breathing care:
  • Continue doing the breathing exercises daily.
  • If the surgery involved lungs, the surgeon may also suggest the use of a spirometer to strengthen your lung after the surgery. Use it four to six times for the initial two weeks after the surgery.
• Activities:
  • Take short walks at least two to three times a day. This will help you to be active after the surgery.
  • You can do light household work after two weeks.
  • You can resume your office work after two to six weeks.
  • Driving is allowed two weeks after the surgery.
  • Avoid playing contact sports like football for two weeks.

When to see the doctor?

Visit or call your healthcare provider immediately if you experience the following symptoms after surgery:

• Fever 
• New chest pain 
• Chills
• Vomiting or lasting nausea
• Swelling, redness, excessive bleeding, or increasing pain from the incision site 
• Discharge from the surgical area
• Cough 
• Pain or swelling in the legs 
• Shortness of breath 
• Constipation even after taking laxatives or a high-fibre diet 
• Yellow, green, or red-coloured mucus in cough

This surgery may carry the following risks:

• Pneumonia
• Shock 
• Infection 
• Blood clots in legs or lungs 
• Damage to the nearby organs or structure 
• Excess bleeding 
• Partial lung collapse
• Air leak from lungs
• Anaesthesia reaction 
• Abnormal heartbeats 
• Empyema (gathering of pus in the chest cavity)

Your follow-up will be scheduled one to two weeks after the surgery to remove the stitches. You will revisit the hospital in about six weeks wherein the surgeon will check the healing of the operated area.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.