VATS Surgical Procedure

22 January, 2019

There is no field that advancements in technology haven’t touch, surgical procedures included. The VATS surgical procedure, or more simplistically, the ‘Video-Assisted Thoracoscopic Surgery’ is one of the newer procedures used to minimize the incision size made for thoracic surgeries. It employs the use of a small video camera (thoracoscope) inserted through a small incision into the thoracic cavity which enables the surgeon visualize the instruments on a video monitor and guide him as he uses them to operate inside the thoracic cavity through small incisions.

This procedure is used in patients who have marginal pulmonary reserves and need to avoid the traditional thoracotomy incision which allows for shorter operating periods; other benefits include lower postoperative morbidity as well as an earlier return to normalcy.

It’s used by surgeons for various procedures including hiatal hernia repair, esophagus surgery, thymus gland removal, thymus sympathectomy for hyperhidrosis (excessive sweating), removal of excessive fluids from the lung cavity, lung surgery including lung volume reduction and biopsy of mediastinal lymphadenectomy for diagnostic purposes, etc. Using VAT in place of the traditional open thoracotomy helps in better management of the patient, with less pain and shorter recovery times.

Surprisingly, the first clinical use of the VATS procedure goes back to 1913 when it was used to perform adhesiolysis in pneumothorax therapy of tuberculosis by introducing a cystoscope into the pleural cavity. However, it was only in the early 1990’s that an upgraded version of the video-assisted thoracoscopic surgery became widely popular and as with laparoscopy, this method too gained more and more applications under its umbrella. The procedure is expected to undergo further refinement in the years to come and be used for more complicated surgeries.

The instruments used for VATS include a 5mm or 10mm fiber-optic scope linked to a camera with 30 degree visualization and mostly laparoscopic instruments. Lung deflation on the side where VATS is being performed is usually done to help in visualization of the procedure being performed; usually an endotracheal tube that enables single lung ventilation is used during the surgery.

In the earlier days before VATS became popular, thoracic surgeries meant opening up of the vault-like chest cavity via large thoracotomy or sternotomy incisions. Quite often, a sternal saw was used to divide the sternum and spread out the opened portion with a sterna retractor (which often lead to rib fractures or splintering), to visualize the area. A traditional thoracotomy requires division of some of the major muscles on the chest wall along with separation of the ribs using a rib spreader. Since the rib spreader can sometimes result in fracturing of the ribs, some thoracic surgeons prefer to intentionally remove a section of one or more ribs to access the required area of the cavity. Though both thoracotomy and sternotomy have proved to be highly effective procedures, the potential for creating a significant amount of pain for an extended period of time along with the danger of fractures, is always there.

With the VATS procedure, this disadvantage doesn’t arise and patients return back to their normal activities in a much shorter time-span.