Video-assisted thoracoscopic surgery

What is video-assisted thoracoscopic surgery (VATS)?

VATS is a surgical procedure used in the chest and lungs. It is a type of 'keyhole' surgery where only very small cuts (incisions) are made to the body. VATS uses a special instrument called a thoracoscope. VATS uses a special instrument called a thoracoscope. This is a thin, tube-like instrument which shines light from the end inserted into the patient. It also transmits images back to an eyepiece or video display so the surgeon can see into the chest cavity. VATS can be used to do a wide range of things, including take small samples of tissues (biopsies) from the lungs. These samples can then be examined in the laboratory.

The surgeon makes two or three small cuts (incisions) in the chest wall near the ribs. These holes are known as ports and are usually about 2 cm long. The surgeon then inserts the thoracoscope through one hole. The thorascope allows the surgeon to see inside the chest. Usually he/she will also insert special surgical instruments into the other incisions. These instruments can be used to remove tissue which may have been seen on an X-ray, or fluid found in the chest. Once the surgery has finished, the instruments are removed and the incisions are closed, usually with stitches.

VATS is used for many different procedures including:

• Taking biopsies from the lung or the lining of the chest.

• Removing lymph nodes.

• Removing lumps or growths from the lung.

• To treat various lung conditions such as fluid accumulating in the lining of the lung (pleural effusion).

VATS is carried out in the operating theatre. Before the procedure, a small needle will be placed in a vein to give you fluids and medications. It is usually done using a general anaesthetic, which means you will be asleep for the surgery. You may also have an epidural. An epidural is a form of pain relief given through a thin tube placed into your back. Once you are asleep you may have a catheter put into your bladder. This is a thin, flexible tube that is inserted into the hole through which you urinate (your urethra) and then advanced into your bladder. This is because the epidural will make it difficult to urinate by yourself. It also allows doctors to measure how much urine you are making. You will be placed on the operating table on your side. Your surgeon will make the cuts (incisions) in your chest and insert the thoracoscope and any other instruments that are needed. After the surgeon has finished the surgery he/she will insert some small tubes into the chest. These are known as 'chest drains' and allow any fluid or air that collects to leak out. Any samples of tissue taken from your chest or lungs will be sent to the laboratory for further testing.

You will slowly be allowed to come around from the anaesthetic. Usually you are given oxygen through a mask. After a while you will be taken back to the ward to rest. The epidural usually stays in until the chest drains are taken out and you are able to take pain relief tablets. Occasionally, although it was planned to use VATS, it is not possible to carry out your operation using keyhole surgery. This means another technique may need to be used. Your doctor should discuss this with you before the procedure.

Your doctor should discuss any specific preparations with you before the surgery. Generally, if you smoke you may be asked to stop before the surgery, as this reduces the chance of breathing problems. If you take 'blood-thinning' medicines (anticoagulants) you may need to stop these for a few days before the surgery. Your doctor should discuss this with you. You may also have some special tests of your lungs to see how well they are working. See separate leaflet called Spirometry for more details. If you are to have a general anaesthetic you will be asked not to eat or drink for a certain length of time before the procedure. Your local hospital will give you information on this.

You will generally stay in hospital for between 3-5 days after the surgery. However, this is a rough guide and will depend on the speed of your recovery. Your surgeon will discuss your progress with you and advise you on how long you should stay. You may be seen by the physiotherapist who may give you some breathing exercises to help prevent infection. You should not expect to be back to full mobility immediately after the operation. Although VATS is a 'keyhole' procedure, the instruments have to pass between the ribs. Sometimes they can press against the nerves which also lie here. This may cause some pain or numbness in the area of the incisions. If this does not go away you should contact your GP or specialist nurse for advice. You will usually be discharged from hospital with a supply of painkillers but it is important you contact your GP for additional supplies.

It is usually easier for patients to recover from video-assisted thoracoscopic surgery (VATS) compared with normal chest surgery (often called 'open' surgery) because the wounds from the cuts (incisions) are much smaller. Air leaks from the lung that don't heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. A very small number of patients have significant bleeding requiring a transfusion or larger operation. It is also possible, although not common, to develop an infection of the wound site or of the lung itself. You should contact your doctor if you become unwell after having VATS. In particular, if you have any of the following problems: high temperature (fever), chest pain, coughing up blood, shortness of breath, or the wound sites becoming red or looking to have pus draining.