Video-assisted thoracic surgery (VATS) is one of the common procedures that your doctor may recommend to diagnose and manage various conditions affecting the chest area.

What are the indications of video-assisted thoracic surgery (VATS)? Your doctor may recommend VATS for:

• Diagnosing or treating lung cancer or cancer that metastasises to the lungs
• Thymic tumours
• Pericardial effusion (fluid surrounding the heart cavity)
• Myasthenia gravis
• Spinal tumours and paraspinal tumours
• Metastatic cancer of the chest
• Lung diseases like chronic obstructive pulmonary disease (COPD), balloon heavy disease and lung infections
• Hyperhidrosis (excessive sweating)
• Lymphoma
• Pneumothorax
• Bronchopleural Fistula

What are the types of VATS? Your surgeon may use video-assisted thoracic surgery (VATS) for various surgeries like:

• The removal of a diseased thymus gland (called thymectomy)
• VATS lung resection is where the surgeon removes a small portion of your lung (called wedge resection), a lobe of the affected lung (called lobectomy) or your entire affected lung (called pneumonectomy)
• Lung volume reduction surgery (LVRS) in which the surgeon removes diseased lung tissue
• Decortication is when the surgeon removes infected material and thickened peel around your affected lung.

What are the preparations required before the VAT procedure? Some of the instructions given by your surgeon are:

• Do not drink or eat several hours before the surgery
• Avoid health supplements or vitamins before the surgery
• Avoid eating some medicines like blood thinners
• Quit smoking completely

Your surgeon may ask you to have some procedures before video-assisted thoracoscopic surgery, including but not limited to:

• Blood investigations, such as complete blood count (CBC)
• Electrocardiogram (EKG)
• Exercise stress test
• Chest X-ray
• CT scan or MRI
• Positron emission tomography (PET) scan
• Pulmonary function testing/ DLCO
• Metabolic exercise stress test
• Upper endoscopy
• Gastrointestinal (GI) X-ray (also called barium swallow) examination

During the VATS Procedure The anesthesiologist will give you anesthesia so that you won’t feel anything during the surgery. The surgeon then:

• Makes a single or multiple 0.25-inch to 0.5-inch incisions in the chest
• Guides a scope inside the chest cavity to get the internal images on a video screen outside
• Insert the instruments for the surgery through other incisions
• With the help of video images, remove the diseased tissue or organs
• Insert a temporary chest tube to extract fluid or air
• Close the incised area with sutures

Potential Risks and Benefits of VATS Procedure Some of the benefits of VAT surgery include:

• It takes less time when compared to open chest surgery (called a thoracotomy)
• Respiratory function takes less time to recover
• The patient feels minimal postoperative pain
• Less risk of infection
• Recovery is rapid, with a faster return to daily routine.

VAT surgery is usually safe with lower chances of complications. Some of the potential risks include:

• Collapsed lung (Pneumothorax)
• Arrhythmias
• Blood loss
• Improper inflation of lung air sacs or atelectasis
• Bruising
• Infections
• Damage to nearby nerves, organs, glands or blood vessels
• Formation of blood clots and strokes
• Hypoxemia (or a condition characterised by low blood oxygen)
• Internal bleeding
• Pneumonia or other respiratory problems

After VATS Procedure Your cardiothoracic surgeon sends the tissue sample for biopsy for a confirmatory diagnosis of cancer, infection, or any other disease. This will determine the further course of treatment. You will be asked to do deep breathing exercises, physiotherapy, and walking to accelerate healing and reduce the chance of complications. Your surgeon will give you some instructions, such as:

• Changing the dressings as advised
• Avoid driving
• Do not go out for a stipulated time
• Do not lift anything heavy
• Take medicines as prescribed

When should I contact my doctor? Call your doctor immediately if you experience

• Pain in chest
• Breathing difficulty
• Experience signs of infections (fever, redness or discharge from the incision site)