VATS is a type of minimally invasive surgery of chest. In this technique a small video camera called thoracoscope is inserted into the chest through a small cut to see inside and surgery is performed using special fine instruments through two or three small incisions (0.5 – 1cm). The thoracoscope transmits the image of inside of thoracic cavity onto a HD monitor. Other name of VATS are thoracoscopy, Thoracoscopic surgery or pleuroscopy.
There are two lungs in our body which serve a basic purpose of supplying oxygen (O2) to the body and remove carbon dioxide (CO2). In most of the people, if needed, we can remove a part of lung (lobectomy) or even whole of one lung(pneumonectomy) without disturbing the basic function of O2 and CO2 exchange because remaining lung expand and take over the function of removed lung.
Advantages of VATS
In VATS we make very small incisions causing very less trauma as compared to traditional “open” surgery in which we make a very long incision (15 to 20 cm), cut the muscles and separate the ribs sometimes causing it’s fracture leading to lot of injury with significant early and long term pain and discomfort. So patient undergoing minimally invasive VATS procedure experience:
- Less pain after surgery
- Reduced bleeding during surgery
- Shorter operative time
- Reduced risk of infection after surgery
- Sorter hospital stay
- They recover more quickly and soon return to work (starting to earn their livelihood)·
- Less incidence of long term (chronic) pain and shoulder dysfunction
- Better quality of life after VATS surgery
Indications and types of VATS procedures
1) VATS Lobectomy
When a large part of lung is removed by minimally invasive technique it is called VATS lobectomy. It is commonly done to treat:
- Lung Cancer
- Fungal infection of lung (Aspergilloma) with bleed (Hemoptysis)
- Hydatid cyst
- Pneumonia (Necrotizing infection/ abscess)
- Bullous lung disease with pneumothorax (air in pleural cavity)
- Congenital conditions (Sequestration)
2) Wedge resection
Surgical removal of a wedge-shaped portion of tissue from lungs to diagnose or treat a lung nodule
Lung biopsy: A small part of lung tissue is removed by VATS technique for diagnostic purpose. The tissue is used for pathological and microscopic examination to identify lung infection or interstitial lung disease.
3) Drainage of pleural effusion
A pleural effusion is accumulation of fluid between the two layers of the pleura (the thin membrane that lines the external surface of lung and inner surface of chest wall). Thecommon causes are infection (Tuberculosis, pneumonia), cancer, heart failure, liver failure and kidney disease. Thoracoscopically we can remove the excess fluid which is causing breathing difficulty and prevent refilling of fluid (recurrence) by instilling sterile talc or an antibiotic in the chest cavity.
4) Mediastinal, Pericardial and Thymus thoracoscopic procedures
The mediastinum is the area in the middle part of chest cavity lying between the two lungs. The area around the heart enclosed by a membrane is called the pericardium. The thymus is a small gland present in the upper and front part of mediastinum.
With the help of VATS we can examine mediastinum or pericardium, remove a part of tissue for diagnostic purpose (biopsy) or surgically remove a benign or malignant (cancerous) growth.
Thymus can be removed (Thymectomy) in a patient of Myasthenia Gravis or thymic tumors (Thymoma)
Other conditions where VATS is useful:
- Esophageal surgery
- Hiatus hernia repair
- Surgery to relieve excessive sweating (Hyperhidrosis)– Thoracic Sympathectomy
- Surgery to relieve Gastroesophageal reflux disease (GERD)
- Treating hernia of Diaphragm or paralysis of diaphragm (eventration)
- Blood Test
- Pulmonary function test (Breathing Test)
- CT Scan