Video-assisted Thorascopic Surgery (VATS)

Video-Assisted Thorascopic Surgery (VATS) is a less invasive way of viewing and taking a sample of abnormal tissue in the lungs that uses an instrument with a camera (thoracoscope) to transmit images to a monitor. This procedure is used to diagnose and treat an infection or disease in or around the lungs. There is no need to make a large incision in the chest and recovery is sometimes faster than other lung surgeries.

Reasons

You may be required to undergo VATS for the following reasons:

  • Accumulation of fluid or air in the space between the inner chest lining and outer lung covering
  • To diagnose diseases found in air spaces of the lungs
  • Presence of pus or fluid around the lungs caused by infection such as pneumonia (empyema)
  • Other reasons would be:
    • Lung cancer
    • Abnormal growth of the lymph nodes in the cavity of the chest (lymphoma)
    • Presence of fluid in the sac of the heart (pericardial effusion)
  • Mesothelioma, which is a cancer in the linings of the heart, abdominal cavity and linings of the chest

Procedure

Prior to the surgery, the anesthetist will put you to sleep and put a large tube in your airway that allows air to be selectively delivered to one lung in isolation. This allows that lung to collapse on the side of the chest where the operation is performed. Dr Orr will have a better view if one of the lungs is partly or completely flattened. This depends on the reason of your surgery.

Small incisions will be made in your skin along the side of your chest. Through the incisions, a thoracoscope (camera) is inserted that sends images to a video screen to serve as a guide in doing the surgery. In order to grasp, biopsy or separate tissue, another small tool is inserted into the other incisions. A suction catheter can also be placed through one of the incisions to drain fluid out of the space between the lung and the chest wall.

After the procedure, the tools will be removed. The flattened lung will be re-inflated and a chest drain will be placed to drain excess air or fluid. The incisions will then be closed.

Risks

Although, patients undergoing VATS surgery often recover faster than those undergoing open chest surgery, there are still some risks. Possible complications for this surgery include:

  • Infection
  • Bleeding
  • Air leaking from the lungs
  • Chest pain
  • Blood clots in the legs that can go to the lungs
  • Proceeding to open chest surgery (if there are new problems identified or the procedure is too difficult or dangerous through small incisions)
  • Problems related to anaesthesia

Conditions that increases the risk:

  • Diagnosed heart or lung condition
  • Obesity
  • Diabetes
  • Previous chest surgery
  • Certain medications

What to expect

Like any other surgery, you are required to sign a consent form after a detailed explanation of the whole procedure. At this point, you may also ask questions or state any concerns regarding the procedure.

You may also need to undergo a series of tests depending on the reason for surgery.

Dr Orr may advise you for:

  • Physical exam and blood tests
  • Pulmonary function tests to check the condition of your lungs
  • CT scan
  • Electrocardiogram (ECG, EKG)
  • Tests to check the condition of your heart

You may be asked to stop or adjust the dose of your medication if you are taking insulin, aspirin, non-steroidal anti-inflammatory drugs, clopidogrel, warfarin or any other anti-coagulant drugs. Discuss this with Dr Orr.

You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anaesthesiologist. Since the procedure involves administration of anaesthetic medicines, you will be asked not to eat for at least six hours before the surgery. Inform the anaesthetist if you have any allergies.

Recovery

After the surgery, you will be given:

  • Fluids and pain medicines (IV)
  • Assistance in changing positions such as sitting up and moving around
  • Instructions on how to perform deep breathing and coughing exercises. You may use a device that will help expand your lungs (spirometer) while doing the exercises
  • A chest x-ray to monitor healing of your lungs
  • Instructions regarding your diet and physical activities

When you are ready to go home, you will be given instructions such as:

  • Exercise (e.g. walking daily)
  • Pain medications. Take them as directed.
  • Continuous use of incentive spirometer and perform deep breathing exercises.
  • You will also be encouraged to cough.
  • Keeping the incision areas clean and dry
  • Information regarding physical activities which should be limited until you have fully recovered.
  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital