• Video-Assisted Thoracic Surgery

    (VATS)

    Definition

    VATS is a type of chest surgery that requires making tiny openings in the chest. During VATS, the doctor makes small, keyhole incisions and uses a tiny camera (called a thoracoscope) and other small tools. Images from the camera are sent to TV monitors. The doctor relies on these images to do the surgery.

    Reasons for Procedure

    VATS is used to diagnose and treat a range of conditions. Common reasons to undergo VATS include:
    • Diagnosing and treating lung cancer
    • Removing diseased lung sections or lobes
    • Diagnosing lung infections
    • Treating collapsed lungs
    • Draining fluid out of the chest cavity
    • Diagnosing and treating of the thymus (organ in the chest)
    Lung Cancer
    IMAGE
    Copyright © Nucleus Medical Media, Inc.
    Compared to traditional procedures, VATS may result in:
    • Less pain and faster recovery
    • Shorter hospital stay
    • Fewer complications
    • Less scarring

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have VATS, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Anesthesia-related problems
    • Air leaking from the lungs
    • Chest pain
    • The need to switch to open chest surgery (eg, to remove a larger area of the lung)
    Some factors that may increase the risk of complications include:
    • Pre-existing heart or lung condition
    • Smoking
    • Obesity
    • Diabetes
    • Previous chest surgery
    • Use of certain medicines
    Discuss these risks with your doctor before surgery.

    What to Expect

    Prior to Procedure

    Depending on the reason for your surgery, your doctor may do the following:
    • Physical exam and blood tests
    • Pulmonary function tests —to help the doctor determine how well your lungs are functioning
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
    • Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
    • Tests to evaluate how well the heart is functioning
    Leading up to the surgery:
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure (eg, aspirin , clopidogrel , warfarin ).
    • If you take insulin, you may need to adjust your dose. Talk to your doctor about this.
    • Arrange for someone to drive you home and to help you at home.
    • Eat a light meal the night before. Do not eat or drink anything after midnight.

    Anesthesia

    VATS is usually done using general anesthesia . This will block pain and keep you asleep during surgery.

    Description of the Procedure

    You will be connected to a ventilator. This is a machine that moves air in and out of your lungs. Depending on the reason you are having VATS, one lung will be completely or partly deflated. This will allow your doctor to have a better view of the chest cavity on that side.
    Several small cuts in the skin will be made along your side. Carbon dioxide gas will be used to fill the chest cavity. The gas will make it easier for the doctor to see internal structures. Through one of the incisions, the doctor will insert the thoracoscope. This camera will send images to the TV monitors. The doctor will rely on these images to do the surgery. Other small tools will be inserted into the cuts. These tools will allow the doctor to grasp, cut, dissect, and suture.
    When the surgery is done, the tools will be removed. The lung will be inflated. A chest tube will be placed to drain any air or fluid. The doctor will close the incisions with sutures or staples.

    Immediately After Procedure

    If you are doing well, the breathing tube will be removed. In the recovery room, the hospital staff will monitor your vital signs. You may be given fluids and medicines through an IV.

    How Long Will It Take?

    1-2 hours (depending on the procedure)

    How Much Will It Hurt?

    You will have pain after surgery. Your doctor will give you pain medicine.

    Average Hospital Stay

    You may be able to go home the next day. If you have VATS for a lobectomy (removal of part of the lung), the usual length of stay is 3-4 days.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may receive the following care:
    • Fluids and pain medicine through an IV line
    • Assistance sitting up and moving around soon after surgery
    • Directions on how to do deep breathing and coughing exercises—You will learn how to use an incentive spirometer. This device helps you expand your lungs when taking a deep breath. This will prevent pneumonia .
    • Chest x-rays to monitor healing—The drainage chest tubes will be removed once your lungs are healed.
    • Instructions about nutrition and physical activity
    At Home
    Follow your doctor’s instructions, which may include:
    • Walk daily.
    • Take pain medicine as directed. Some pain medicine causes constipation . To prevent this, drink plenty of fluids and eat high-fiber foods.
    • Continue to use the incentive spirometer. Do deep breathing. You will also be encouraged to cough.
    • Keep the incision area clean and dry.
    • Limit certain activities until you have recovered.
    Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Cough or shortness of breath
    • Coughing up yellow, green, or bloody mucus
    • New chest pain
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
    • Difficulty urinating (eg, pain, burning, urgency, frequency, or bleeding)
    • Pain and/or swelling in your feet, calves, or legs
    • Persistent nausea, vomiting, and/or diarrhea
    • Headache, feeling faint or dizzy
    • Other worrisome symptoms
    Call for medical help or go to the emergency room right away if any of the following occurs:
    • Sudden chest pain
    • Sudden shortness of breath
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American College of Surgeons http://www.facs.org/

    Society of Thoracic Surgeons http://www.sts.org/

    CANADIAN RESOURCES

    Canadian Lung Association http://www.lung.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    A patient’s guide to lung surgery: recovering at the hospital. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-recoveringinthehospital.html . Accessed March 9, 2010.

    A patient’s guide to lung surgery: recovering at home. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-recoveringathome.html . March 9, 2010.

    A patient’s guide to lung surgery: when to call the doctor. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-whentocallyourdoctor.html . Accessed March 9, 2010.

    Pulmonary lobectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2009. Accessed March 8, 2010.

    Robot-assisted laparoscopic procedures. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed March 8, 2010.

    Robot-assisted thoracic procedures. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed March 8, 2010.

    Video-assisted thoracic surgery. Harvard Health Publications website. Available at: http://www.health.harvard.edu/diagnostic-tests/video-assisted-thoracic-surgery.htm . Accessed March 8, 2010.

    Video-assisted thorascopic surgery (VATS). Rush University Medical Center website. Available at: http://www.rush.edu/rumc/page-1160429783340.html . Accessed March 8, 2010.

    Video-assisted thoracoscopic surgery (VATS). Mayo Clinic website. Available at: http://www.mayoclinic.org/video-assisted-thoracic-surgery . Accessed March 8, 2010.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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