Video-assisted thoracoscopic surgery (VATS) is a type of

minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...

thoracic surgery Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal struc ...

performed using a small

video camera A video camera is an optical instrument that captures videos (as opposed to a movie camera, which records images on film). Video cameras were initially developed for the television industry but have since become widely used for a variety of other ...

mounted to a

fiberoptic An optical fiber, or optical fibre in Commonwealth English, is a flexible, transparent fiber made by drawing glass (silica) or plastic to a diameter slightly thicker than that of a human hair. Optical fibers are used most often as a means t ...

thoracoscope Thoracoscopy is a medical procedure involving internal examination, biopsy and/or resection/drainage of disease or masses within the pleural cavity, usually with video assistance. Thoracoscopy may be performed either under general anaesthesia ...

(either 5 mm or 10 mm caliber), with or without angulated visualization, which allows the

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

to see inside the chest by viewing the

video Video is an electronic medium for the recording, copying, playback, broadcasting, and display of moving visual media. Video was first developed for mechanical television systems, which were quickly replaced by cathode-ray tube (CRT) syste ...

images relayed onto a

television screen A display device is an output device for presentation of information in visual or tactile form (the latter used for example in tactile electronic displays for blind people). When the input information that is supplied has an electrical signal the ...

, and perform procedures using elongated

surgical instrument A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...

s. The camera and instruments are inserted into the patient's

chest cavity The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. There ...

through small incisions in the

chest wall The thoracic wall or chest wall is the boundary of the thoracic cavity. Structure The bone, bony human skeleton, skeletal part of the thoracic wall is the rib cage, and the rest is made up of muscle, skin, and fasciae. The chest wall has 10 lay ...

, usually via specially designed guiding tubes known as "ports". VATS procedures are done using either conventional surgical instruments or

laparoscopic Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medlin ...

instruments. Unlike with laparoscopy,

carbon dioxide Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...

insufflation In religious and magical practice, insufflation and exsufflation are ritual acts of blowing, breathing, hissing, or puffing that signify variously expulsion or renunciation of evil or of the devil (the Evil One), or infilling or blessing with goo ...

is not generally required in VATS due to the inherent rigidity of the

thoracic cage The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels. The sternum, together known as the thoracic cage, is a sem ...

. However, lung deflation on the side of the operated chest is a must to be able to visualize and pass instruments into the thorax; this is usually effected with a

double-lumen endotracheal tube A double-lumen endotracheal tube (also called double-lumen endobronchial tube or DLT) is a type of endotracheal tube which is used in tracheal intubation during thoracic surgery and other medical conditions to achieve selective, one-sided ventilat ...

that allows for single-lung ventilation, or a one-side bronchial occlusion delivered via a standard single-lumen

tracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are a ...

History

VATS came into widespread use beginning in the early 1990s. Operations that traditionally were carried out with thoracotomy or sternotomy that today can be performed with VATS include: biopsy for diagnosis of

pulmonary The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

pleural The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication bet ...

or mediastinal pathology; decortication for empyema;

pleurodesis Pleurodesis is a medical procedure in which part of the pleural space is artificially obliterated. It involves the adhesion of the visceral and the costal pleura. The mediastinal pleura is spared. Uses Pleurodesis is performed to prevent recurre ...

for recurrent

pleural effusions A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung. Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kil ...

or spontaneous

pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve ...

;

surgical stapler Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, a ...

-assisted

wedge resection Wedge resection is a surgical procedure to remove a triangle-shaped slice of tissue. It may be used to remove a tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm ...

of lung masses; resection of mediastinal or pleural masses; thoracic sympathectomy for

hyperhidrosis Hyperhidrosis is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. Although primarily a benign physical burden, hyperhidrosis can deteriorate quality of life from a psychologi ...

; operations for

diaphragmatic hernia Diaphragmatic hernia is a defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity. Treatment is usually surgical. Types * Congenital diaphragmatic hernia ** Morgagni's hernia ** Bochdalek hernia * Hiatal h ...

s or paralysis; esophageal resection or resection of esophageal masses or

diverticula In medicine or biology, a diverticulum is an outpouching of a hollow (or a fluid-filled) structure in the body. Depending upon which layers of the structure are involved, diverticula are described as being either true or false. In medicine, t ...

; and

VATS lobectomy Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery. Traditional approach to lung cancer surgery: thoracotomy Anatomic lung resection, i.e. pulmonary lobectomy or pneumonectomy, in conjunction with rem ...

/mediastinal

lymphadenectomy Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the ...

for lung cancer. Similarly to

laparoscopy Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...

, VATS has enjoyed widespread use for technically straightforward operations such as pulmonary

decortication Decortication is a medical procedure involving the surgical removal of the surface layer, membrane, or fibrous cover of an organ. The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung ex ...

, and lung or pleural biopsies, while more technically demanding operations such as esophageal operations, mediastinal mass resections, or pulmonary lobectomy for early stage lung cancer, have been slower to catch on and have tended to remain confined to selected centers. It is expected that advanced VATS techniques will continue to grow in numbers spurred by patient demand and greater surgeon comfort and familiarity with the techniques.

Benefits

The main advantage of VATS is that the smaller postoperative wounds drastically reduce the risk for

wound infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

and dehiscence, which allows for a faster recovery by the patient and a greater chance for the wound to heal. Traditional thoracic surgery requires opening the chest through

thoracotomy A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the hea ...

or sternotomy incisions, which are significantly traumatic to the body. Sternotomy requires the use of a sternal saw to split the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...

and a retractor to spread apart the divided sternum to allow visualization and access to the thoracic structures. Thoracotomy, as most commonly performed, requires division of one or more major muscles of the chest wall including the latissimus, pectoralis or serratus muscles, along with spreading of the ribs with a

rib spreader A rib spreader, also known as Finochietto retractor, is a type of retractor specifically designed to separate ribs in thoracic surgery. Rack-and-pinion-type stainless steel rib spreaders (with a thumb-screw to lock it in place) were an innovation ...

. Because the

costovertebral joint The costovertebral joints are the joints that connect the ribs to the vertebral column. The articulation of the head of the rib connects the head of the rib to the bodies of the thoracic vertebrae. Structure The costotransverse joint connects th ...

s have only limited flexibility, the use of a rib spreader usually results in

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...

rib fracture A rib fracture is a break in a rib bone. This typically results in chest pain that is worse with inspiration. Bruising may occur at the site of the break. When several ribs are broken in several places a flail chest results. Potential complicatio ...

s, which can lead to complications like a

flail chest Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath ...

or intercostal

neuralgia Neuralgia (Greek ''neuron'', "nerve" + ''algos'', "pain") is pain in the distribution of one or more nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal neuralgia. Classification Under the general heading of neuralg ...

. Because of this, thoracic surgeons generally intentionally use a

bone cutter A bone cutter is a surgical instrument used to cut or remove bones. In addition to surgery, they are also used in forensics, torture, and dismemberment. Types of medical bone cutters include: * Unpowered – Unpowered bone cutting implements ...

to remove section of one or more ribs in an effort to prevent jagged rib fractures. Although sternotomy and thoracotomy have been proven over decades to provide highly effective access to thoracic structures and in general are tolerated by patients, both incisions have the potential for causing significant pain that may last for extended periods and both prevent the patients from heavy lifting or strenuous activity for weeks in order to heal, and can still result in

malunion A malunion is when a fractured bone does not heal properly. Some ways that it shows is by having the bone being twisted, shorter, or bent. Malunions can occur by having the bones improperly aligned when immobilized, having the cast taken off to ...

s and

nonunion Nonunion is permanent failure of healing following a broken bone unless intervention (such as surgery) is performed. A fracture with nonunion generally forms a structural resemblance to a fibrous joint, and is therefore often called a "false joi ...

s. The great advantage of VATS over sternotomy or thoracotomy is the avoidance of muscle division and bone-cutting, which allows for reduced

postoperative pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

, shorter duration of hospital stay and quicker return to full activity.

References

External links

* {{Thoracic surgery Thoracic surgical procedures Pulmonary thoracic surgery

History

Benefits

See also

References

Further reading

External links