What is VATS?
VATS or Video Assisted Thoracoscopic Surgery is a keyhole procedure where several 1-centimetre incisions are made in the chest, and a special instrument with a small video camera at the end is inserted by the surgeon in one of the incisions. The camera feeds video images to a computer screen allowing the surgical team to see inside your chest. The surgeon will also insert other special surgical instruments into the other incisions, which can then be used to examine the lungs and the chest lining (the pleura), obtain pleural biopsies and remove fluid from the chest. Collapsed lung can also be repaired and reinflated using this technique.
What is thoracotomy?
A thoracotomy is a type of operation allowing the surgeon to gain direct access to your lung and perform a lung resection. Your surgeon will make a cut on the affected side of your chest and access your lung by spreading the ribs. Both thoracotomy and VATS are usually performed under general anaesthesia, and your lung may or may not be deflated. If the lung is to be examined or operated on by the surgeon, then it will likely be deflated during the procedure.
A special breathing tube, placed in your mouth by the anaesthetist, will help your other lung to continue to work and breathe for you.
VATS or thoracotomy?
During your consultation with the surgeon, they will advise you on the most appropriate surgical approach for you. You may be asked to consent to both VATS and thoracotomy so that the surgeons can proceed with the right approach if the clinical necessity arises.
Why would I need VATS?
This surgical method can be used to:
- Perform a lobectomy which is the removal of part of the lung containing a lung lesion.
- Examine lining of the chest wall (pleura) and obtain biopsies.
- Drain a pleural effusion, which is a build-up of fluid in the lining of the right or left lung.
- Treat a pneumothorax when the lung has collapsed.
- Treat bullous disease by removing lung tissue containing little air-filled pockets called bullae.
- Perform a talc pleurodesis (the thoracic pre-assessment nursing team will provide you with additional advice if this procedure is also considered).
Why would I need a thoracotomy?
Thoracotomy allows your surgeon to do a:
- Lobectomy - the removal of part of the lung containing a lung lesion.
- Segmentectomy / Wedge Resection - the removal of a much smaller part of the lung than a whole lobe.
- Pneumonectomy - removal of the whole lung.
- Lymph node resection – removal of lymph nodes associated with the affected part of the lung.
- Lung decortication – removal of the surface layer of the lung, for example if it is damaged by infection.
- Clagett window – a rare procedure to create an opening on the side of your chest to treat infection.
Will I have drains after the surgery?
After your VATS / thoracotomy you will likely have one or two chest drains inserted on the same side as your surgical incision. Their aim is to remove any extra air, fluid or blood that might collect in the chest. The drain(s) will normally remain in place for 24-48 hours after your procedure, or occasionally longer, depending on the amount of drainage of blood or fluid or air present. The nurses and doctors will frequently monitor your drains and inform you of the plan regarding their removal. You may also have a chest Xray.
What happens after surgery?
The length of your hospital stay after VATS / thoracotomy is usually 3-5 days if there are no delays in your post-operative recovery. Some of the complications that may occur post-operatively are:
- air leak from the reinflated lung
- persistent drainage of fluid
- bleeding
- chest infection
- wound infection
What are the risks?
All treatments carry a certain degree of risk. When you are signing your consent form, the surgeon will discuss with you the risks and benefits of the surgery, and you will have the opportunity to ask questions. Any risks associated with general anaesthesia will be explained to you by the anaesthetist on the morning of your procedure.