What is VATS (Video-Assisted Thoracic Surgery)?

Video-Assisted Thoracic Surgery, or VATS, is a process that allows doctors to operate on your chest without making extensive cuts. Instead, they use small holes to insert a tiny camera and special tools inside your chest. The camera shows them what is going on inside on a computer screen. It helps them fix problems like lung issues or other conditions in your chest. Because they use small holes, you feel less pain, heal faster, and have more minor scars than big cuts.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical procedure used to treat various chest diseases, including lung cancer, empyema, and thoracic aortic aneurysms.

According to historical records, the first clinical application of VATS dates back to 1913, when adhesiolysis was performed to enhance pneumothorax tuberculosis therapy via a cystoscope introduced into the pleural cavity. This early attempt paved the way for developing VATS as a surgical technique. ( Video-Assisted Thoracoscopic Surgery (VATS) – Medscape)

It was in the 1980s that VATS gained wider acceptance for thoracic surgeries. In 1981, Dr. Harry Bailey performed the first VATS lobectomy in the United States, marking a significant milestone in demonstrating the feasibility and safety of using VATS for major lung resections. (The Evolution of Minimally Invasive Thoracic Surgery: Implications for the Practice of Uniportal Thoracoscopic Surgery – PMC)

Over the years, VATS has gained popularity as a procedure for various thoracic conditions. According to medical experts, VATS offers several advantages over traditional open thoracotomy surgery, including reduced postoperative pain, shorter hospital stays, and faster recovery times. (A Glance at the History of Uniportal Video-Assisted Thoracic Surgery – PMC and History and development of minimally invasive surgery: VATS surgery - AME Publishing).

One can trace the history of VATS (video-assisted thoracoscopic surgery) in India back to the early 1990s. In 1992, the All India Institute of Medical Sciences (AIIMS) in New Delhi performed the first VATS lobectomy in India. It marked a significant breakthrough, demonstrating VATS's safe and effective use for major lung resections within the country.

This pioneering work laid the foundation for the growth of VATS in India. Over time, VATS has gained prominence and is now the established approach for managing various thoracic conditions.

Subsequently, India has witnessed several critical milestones in the evolution of VATS:

• 1994: Establishment of The VATS Society of India, aimed at promoting the advancement of VATS surgery.
• 1998: VATS lobectomy is successfully performed in rural healthcare settings, broadening its accessibility.
• 2002: VATS surgery receives coverage under the government's health insurance scheme, enhancing its availability to more patients.
• 2010: The annual count of VATS procedures surpasses 10,000, reflecting its increasing adoption and success.

VATS has rapidly evolved into a significant field in Indian medical practice. This minimally invasive technique offers a safe and effective alternative to traditional open thoracotomy surgery, leading to its adoption as the country's preferred standard of care for various thoracic conditions.

• VATS lobectomy: Imagine you have a problem in a part of your lung, like a wrong spot. In a lobectomy, doctors use small holes and special tools to remove that bad part, leaving the healthy parts behind.
• VATS wedge resection: Sometimes, there's a small problem in your lung that doctors need to check. In a wedge resection, doctors remove just a tiny piece of the lung to see if the condition is severe.
• VATS bullectomy: If big air pockets in your lung are causing trouble, doctors can remove them in a bullectomy. It helps your lungs work better.
• VATS pleurodesis: Imagine there's extra water around your lung that's making it hard to breathe. In pleurodesis, doctors make the lung's outer layer rough so it sticks to the inside of your chest. It helps stop the extra water from coming back.
• VATS decortication: If there's gunk or infection around your lung, like a sticky mess, doctors can clean it up in decortication. They take away the messy stuff so your lungs can work normally again.
• VATS biopsy: Sometimes doctors need to check a tiny piece of your lung to see if it's healthy. They do this by taking a little sample using small tools through tiny holes.
• VATS sympathectomy: If you sweat too much or have pain, doctors can cut or stop specific nerves near your spine to help fix the problem.
• VATS thymectomy: The thymus is like a little organ in your chest. If it's causing trouble, doctors can remove it using small holes and special tools.
• VATS esophageal surgery: If your food pipe (esophagus) has a problem, doctors can fix it using VATS. It's like a bit of repair inside your chest.
• VATS mediastinal mass resection: If there's something strange in the middle of your chest, doctors can take it out using small holes and special tools.

The following are the steps of VATS procedure:

• Preparation: Before the procedure, a consultation with your medical team occurs. The team provides comprehensive explanations and ensures your comfort. Depending on the case, you may receive anesthesia for sedation during surgery or a localized numbing agent.
• Small incisions: The surgeon initiates the process by making discreet incisions on your chest. These incisions are notably smaller than those in conventional surgery. These entry points facilitate the introduction of specialized instruments.
• Camera insertion: A miniature camera, thoracoscope, is introduced through one of the incisions. This device transmits visual information to a screen in the operating room, allowing the surgeon a real-time view of the internal chest cavity.
• Tool insertion: Via the remaining incisions, the surgeon introduces specialized tools. These instruments serve diverse functions, encompassing grasping, cutting, and suturing capabilities.
• Procedure: The surgeon performs the necessary procedures using the camera and instruments. For instance, the surgeon meticulously excises the problematic lung section in a lobectomy. Throughout this process, the surgeon relies on the visual feedback from the screen to guide their actions.
• Closure: Upon concluding the procedure, the camera and instruments are removed. The incisions are meticulously closed using sutures or staples. The size of these incisions is such that resultant scars are notably more minor compared to those resulting from conventional surgical techniques.
• Recovery: Following the surgery, you transition to a recovery phase. As the anesthesia wears off, you regain alertness under medical observation. Once deemed stable, you are transferred to a standard hospital room. Notably, the recovery period is often less than traditional surgical approaches.

The indications and contraindications of VATS depend on various factors, such as: 

• Patient's medical condition
• The surgeon's expertise 
• The availability of infrastructure

Indications for VATS Procedure:

• Lung cancer: Researchers have extensively studied VATS's effectiveness in treating lung cancer. Studies have shown that VATS lobectomy is associated with less postoperative pain, shorter hospital stays, and similar oncologic outcomes compared to open surgery. (Sources: Cao C et al., 2013; Paul S et al., 2010)
• Diagnostic biopsies: Research highlights the accuracy and safety of VATS for obtaining lung tissue samples, aiding in accurate diagnosis and appropriate treatment planning. (Source: Sihoe AD, 2010)
• Pleural effusion and empyema: VATS help diagnose and manage pleural effusion and empyema. Compared to open procedures, it's associated with shorter hospital stays and decreased postoperative pain. (Sources: Sihoe AD, 2010; Lee PC et al., 2003)
• Lung bullae: Studies have reported successful outcomes of VATS in treating patients with larger lung bullae, improving lung function and quality of life. (Source: Kim ES et al., 2008)
• Mediastinal tumors: Doctors have found VATS effective and safe for resecting mediastinal tumors, providing less postoperative pain and faster recovery. (Source: Sihoe AD, 2010)
• Thymectomy: Research suggests that VATS thymectomy is a valid alternative to open thymectomy, providing similar clinical outcomes with shorter hospital stays and reduced pain. (Source: Zielinski M et al., 2014)

Contraindications for VATS Procedure:

• Extensive scarring: Prior surgeries and significant scarring can hinder VATS due to limited visualization and technical difficulties. (Source: Demmy TL et al., 2000)
• Advanced disease: The doctor may prefer open surgery for complete tumor removal in advanced lung cancer stages or cases with extensive spread. (Source: Sihoe AD, 2010)
• Unstable health: VATS requires anesthesia and surgical stress, which might not be suitable for patients with unstable health conditions. (Source: Scott WJ et al., 2013)
• Severe bleeding disorders: Patients with bleeding disorders might have increased bleeding risks during VATS procedures. (Source: Dunning J et al., 2010)
• Large tumors: Tumors that are too large to remove through small incisions safely might require open surgery. (Source: Sihoe AD, 2010)
• Obesity: Obesity might pose challenges during VATS due to limited space and increased risks of complications. (Source: Sihoe AD, 2010)
• Inadequate surgical expertise: The successful outcome of VATS procedures is heavily dependent on surgeon expertise. Procedures performed by less experienced surgeons might carry increased risks. (Source: Sihoe AD, 2010)

The following are some of the risks involved in the VATS procedure:

• Prolonged air leak: After VATS surgery, a common issue is when air leaks from the lung into the space around it. Think of it like air escaping from a balloon. A study in the "Chest" journal found that this happens in around 10-20% of cases.
• Bleeding: Bleeding can happen during any surgery, but it's a bit more likely with VATS. This is because doctors work in a tight space. In the "Annals of Thoracic Surgery" journal, it's said that about 2-5% of the time, bleeding can be severe enough to switch to a different surgery.
• Infection: Infections are a risk with any surgery, but they are less common with VATS than more extensive surgeries. A journal study mentioned that around 2-4% of people might get an infection after VATS surgery.
• Pneumonia: Pneumonia, which is a lung infection, can show up after surgery. It is more likely with VATS because the minor cuts can let in germs. "Chest" journal found that around 2-5% of people might get pneumonia after VATS surgery.
• Recurrent pneumothorax: Sometimes, the lung can collapse after surgery, even after your doctor has treated it. This phenomenon is rare, but it is a severe complication. The journal "The Annals of Thoracic Surgery" says around 0.5-1% of people might face this after VATS surgery.
• Conversion to open thoracotomy: Once in a while, during VATS surgery, things might get complicated. In these cases, doctors might have to change the plan and use open surgery instead. It could be due to heavy bleeding or other unexpected problems. "The Journal of Thoracic and Cardiovascular Surgery" found that around 5-10% of VATS surgeries might need to switch like this. It's like taking a different route because the regular road is blocked.

The recovery depends on person to person. Some essential aspects of the recovery are:

 1. Hospital stay: After the VATS procedure, you'll spend a few days in the hospital. The length depends on how complex the surgery was. For simpler procedures, you might stay for 1-2 days. If it's more complicated, your stay could be more extended.

2. Pain and discomfort: You might feel some pain around where the surgeon has made the cuts. It is normal. Doctors will give you medicines to help with the pain. With time, the pain should get better as you heal.

3. Breathing and coughing: Breathing might feel different after the surgery, and you might cough more. Your doctor will show you how to do special breathing exercises. These exercises help keep your lungs healthy and clear.

4. Taking it easy: At first, you'll need to take it easy. Avoid heavy lifting and doing things that make you tired. Gradually, you can start doing light activities like walking, following your doctor's advice.

5. Getting back to normal: When you can go back to your usual routine depends on the surgery and how quickly you heal. Some people might return to work within a few weeks, while others might need more time.

6. Follow-up with your doctor: You'll have appointments with your doctor to check how you're doing. These visits help make sure you're healing well and can address any questions you might have.

7. Scars: The small scars from the surgery will fade over time. They might look red or raised initially, but they usually get better as time passes.

8. PossiblepProblems: While most people recover without problems, there's a chance of complications. It could include infections, bleeding, or lung or chest issues. If you notice anything unusual, it is essential to let your doctor know.

Research has shown that after VATS surgery, people usually spend less time in the hospital, feel less pain, and recover faster than traditional open thoracotomy surgery. The outcomes of VATS surgery for treating conditions like lung cancer are similar to those of open surgery. Some of the studies that documented the efficacy of VATS surgery are:

• Shorter hospital stay: A study in the "Chest" journal found that people stayed in the hospital for about four days on average after VATS lobectomy. In comparison, after an open thoracotomy, it was around seven days.
• Less pain: Another study in the "Annals of Thoracic Surgery" revealed that people reported significantly less pain after VATS lobectomy than open thoracotomy.
• Faster recovery: Research in "The Journal of Thoracic and Cardiovascular Surgery" discovered that people with VATS lobectomy could return to normal activities sooner than those with open thoracotomy.
• Survival rate: A study in the "Cancer" journal found that for people with lung cancer who had VATS lobectomy, the 5-year survival rate was about 70%. It was similar to the survival rate for those who had open thoracotomy.

What does VATS surgery stand for?

VATS stands for Video-Assisted Thoracoscopic Surgery, a minimally invasive surgical technique for treating chest and lung conditions.

How is VATS surgery different from traditional open surgery?

VATS surgery involves small incisions and uses a camera to guide the surgeon, while traditional open surgery requires a larger incision to access the chest.

What conditions can be treated with VATS surgery?

VATS surgery can treat lung cancer, pneumothorax (collapsed lung), pleural effusion, and more.

How is VATS surgery performed?

VATS surgery involves making small incisions, inserting a camera and instruments, and operating while watching a video screen.

Is VATS surgery performed under general anesthesia?

Yes, most VATS surgeries are performed under general anesthesia to ensure you're asleep and comfortable during the procedure.

What are the benefits of VATS surgery?

Benefits include smaller incisions, less pain, quicker recovery, shorter hospital stays, and reduced scarring.

Is VATS surgery safe?

VATS surgery is generally safe, but like any surgery, it carries some risks. Your surgeon will discuss these with you.

How long does it take to recover from VATS surgery?

Recovery times vary, but most people can return to light activities within a few weeks and resume regular activities within a few months.

Will I have scars after VATS surgery?

You'll have small scars where the incisions were made. Over time, these scars tend to fade and become less noticeable.

Can VATS surgery be used for lung cancer treatment?

VATS surgery can be a choice for lung cancer treatment, especially for removing small tumors or parts of the lung.

Are there any risks associated with VATS surgery?

Risks include infection, bleeding, prolonged air leak, and rare complications like damage to nearby structures.

How long must I stay in the hospital after VATS surgery?

Hospital stays can vary, but for more straightforward procedures, you might stay 2-4 days, while more complex surgeries could require a more extended stay.

Can VATS surgery be used for diagnosing lung conditions?

VATS can be used for diagnostic purposes, allowing the surgeon to take tissue samples for examination.

Is VATS surgery suitable for all patients?

VATS surgery might only be suitable for some. Your doctor will assess your case to determine if you're a candidate.

How soon can I resume normal activities after VATS surgery?

Depending on the surgery's complexity, you might resume light activities within a few weeks and regular activities in a few months.

Will I need pain medication after VATS surgery?

Healthcare provider may prescribe pain medication to manage discomfort during the recovery period. Your medical team will adjust the dosage as needed.

What is a VATS lobectomy?

A VATS lobectomy removes a portion of the lung, often used in cancer treatment.

Is VATS surgery suitable for children?

VATS surgery is feasible for children, but the decision depends on the child's condition and the surgeon's recommendation.

Can VATS surgery be used for treating infections in the chest?

VATS surgery can treat conditions like empyema.  Empyema is a collection of pus in the chest cavity.

Will I need to have stitches removed after VATS surgery?

Stitches or staples used for incisions may need removal, but dissolvable stitches often eliminate the need for removal.

What is the difference between VATS and robotic-assisted surgery?

Both are minimally invasive techniques, but in robotic-assisted surgery, the surgeon uses a robotic system to control the instruments.

Can VATS surgery be performed on both sides of the chest?

The surgeon can perform VATS surgery on both the left and right sides of the chest, depending on the condition.

How long does a VATS surgery usually take?

The duration of a VATS surgery can vary, but it typically takes a few hours, depending on the complexity of the procedure.

Can VATS surgery be used for treating non-cancerous conditions?

VATS surgery can be a choice for treating non-cancerous conditions like pleural effusion or pneumothorax.

Are there any age restrictions for VATS surgery?

Age itself is not a restriction. The decision depends on the patient's overall health and ability to undergo surgery.

Can VATS surgery be used for removing tumors in the chest?

VATS surgery can remove tumors located within the chest, including those in the lung.

What is the success rate of VATS surgery?

The success rate varies depending on the specific condition, the patient's physical status, and the skill of the surgical team.

Can VATS surgery be performed during pregnancy?

Your doctor generally avoids VATS surgery during pregnancy unless it's urgent due to potential risks to the mother and the fetus.

How soon can I drive after VATS surgery?

The doctor may suggest you to restrict driving for a few weeks after VATS surgery. Your doctor will advise you when it's safe to resume driving.

Is there a risk of complications after VATS surgery?

Like any surgery, VATS surgery carries some risks of complications. Your surgeon will discuss these risks with you before the procedure.

Will I need to change my diet after VATS surgery?

Your diet might need to be adjusted temporarily after surgery. Your medical team will provide dietary guidelines based on your condition.

What type of anesthesia is best for VATS surgery?

VATS surgery is usually under general anesthesia, which means you'll be asleep during the procedure.

Can VATS surgery be used for removing cysts in the chest?

The doctor may employ VATS surgery to remove cysts or other abnormal growths in the chest.

Are there any long-term effects of VATS surgery?

Most patients do not experience long-term effects after VATS surgery. However, individual outcomes may vary.

Will I need physical therapy after VATS surgery?

The doctor may recommend physical therapy to help recover and regain strength after VATS surgery, especially for more complex procedures.

How can I prepare for VATS surgery?

Your medical team will provide specific preparation instructions, including fasting before surgery and adjusting medications.

What happens if complications arise during VATS surgery?

If complications occur during VATS surgery, the surgical team can address them promptly and take necessary actions.

Can VATS surgery treat chronic obstructive pulmonary disease (COPD)?

VATS surgery is not a primary treatment for COPD, but it might be considered to manage complications or related conditions in some instances.

Will I need to stop any medications before VATS surgery?

Some medications might need to be paused before surgery, especially those that affect blood clotting. Your doctor will provide guidance.

How can I manage pain at home after VATS surgery?

Your doctor will prescribe pain medications to manage discomfort at home. Follow their instructions for proper use.

Can VATS surgery be performed on elderly patients?

Age alone is not a barrier. The decision to perform VATS surgery on elderly patients depends on their overall health and ability to tolerate the procedure.

Will I need to have follow-up appointments after VATS surgery?

Follow-up appointments are essential to monitor your recovery progress and ensure that everything is healing well.

Is it possible to have complications after leaving the hospital post-VATS surgery?

A: While complications are rare after leaving the hospital, you should be vigilant and report any unusual symptoms to your doctor promptly.

Can VATS surgery be used for treating tuberculosis in the chest?

VATS surgery might be considered for treating certain complications of tuberculosis, but it's not a primary treatment for tuberculosis itself.

How soon can I take a shower after VATS surgery?

You can shower a few days after VATS surgery once your doctor gives you the green light. Follow their instructions.

Can VATS surgery be used for lung transplant procedures?

Your doctor may not advise VATS surgery for lung transplant procedures due to the complexity and nature of the surgery.

Will I need to wear special clothing after VATS surgery?

Your doctor might recommend loose and comfortable clothing to avoid putting pressure on the incision sites.

How do I know if VATS surgery is right for me?

Your doctor will discuss your medical history, condition, and the pros and cons of VATS surgery to determine if it's the best choice for you.