Health Library

Video-Assisted Thoracic Surgery

(VATS)

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

VATS is a type of chest surgery that requires making tiny openings in the chest. During VATS, the doctor makes small, keyhole incisions and uses a tiny camera (called a thoracoscope) and other small tools. Images from the camera are sent to TV monitors. The doctor relies on these images to do the surgery.

Reasons for Procedure

VATS is used to diagnose and treat a range of conditions. Common reasons to undergo VATS include:

Diagnosing and treating lung cancer
Removing diseased lung sections or lobes
Diagnosing lung infections
Treating collapsed lungs
Draining fluid out of the chest cavity
Diagnosing and treating of the thymus (organ in the chest)

Lung Cancer

Compared to traditional procedures, VATS may result in:

Less pain and faster recovery
Shorter hospital stay
Fewer complications
Less scarring

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have VATS, your doctor will review a list of possible complications, which may include:

Infection
Bleeding
Anesthesia-related problems
Air leaking from the lungs
Chest pain
The need to switch to open chest surgery (eg, to remove a larger area of the lung)

Some factors that may increase the risk of complications include:

Pre-existing heart or lung condition

Smoking
Obesity
Diabetes
Previous chest surgery
Use of certain medicines

Discuss these risks with your doctor before surgery.

What to Expect

Depending on the reason for your surgery, your doctor may do the following:

Physical exam and blood tests

Pulmonary function tests —to help the doctor determine how well your lungs are functioning
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
Tests to evaluate how well the heart is functioning

Leading up to the surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure (eg, aspirin , clopidogrel , warfarin ).
If you take insulin, you may need to adjust your dose. Talk to your doctor about this.
Arrange for someone to drive you home and to help you at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.

VATS is usually done using general anesthesia. This will block pain and keep you asleep during surgery.

You will be connected to a ventilator. This is a machine that moves air in and out of your lungs. Depending on the reason you are having VATS, one lung will be completely or partly deflated. This will allow your doctor to have a better view of the chest cavity on that side.

Several small cuts in the skin will be made along your side. Carbon dioxide gas will be used to fill the chest cavity. The gas will make it easier for the doctor to see internal structures. Through one of the incisions, the doctor will insert the thoracoscope. This camera will send images to the TV monitors. The doctor will rely on these images to do the surgery. Other small tools will be inserted into the cuts. These tools will allow the doctor to grasp, cut, dissect, and suture.

When the surgery is done, the tools will be removed. The lung will be inflated. A chest tube will be placed to drain any air or fluid. The doctor will close the incisions with sutures or staples.

If you are doing well, the breathing tube will be removed. In the recovery room, the hospital staff will monitor your vital signs. You may be given fluids and medicines through an IV.

1-2 hours (depending on the procedure)

You will have pain after surgery. Your doctor will give you pain medicine.

You may be able to go home the next day. If you have VATS for a lobectomy (removal of part of the lung), the usual length of stay is 3-4 days.

While you are recovering at the hospital, you may receive the following care:

Fluids and pain medicine through an IV line

Assistance sitting up and moving around soon after surgery

Directions on how to do deep breathing and coughing exercises—You will learn how to use an incentive spirometer. This device helps you expand your lungs when taking a deep breath. This will prevent pneumonia.
Chest x-rays to monitor healing—The drainage chest tubes will be removed once your lungs are healed.
Instructions about nutrition and physical activity

Follow your doctor’s instructions, which may include:

Walk daily.

Take pain medicine as directed. Some pain medicine causes constipation. To prevent this, drink plenty of fluids and eat high-fiber foods.
Continue to use the incentive spirometer. Do deep breathing. You will also be encouraged to cough.
Keep the incision area clean and dry.
Limit certain activities until you have recovered.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Cough or shortness of breath

Coughing up yellow, green, or bloody mucus

New chest pain

Signs of infection, including fever and chills

Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site

Difficulty urinating (eg, pain, burning, urgency, frequency, or bleeding)

Pain and/or swelling in your feet, calves, or legs

Persistent nausea, vomiting, and/or diarrhea
Headache, feeling faint or dizzy
Other worrisome symptoms

Call for medical help or go to the emergency room right away if any of the following occurs:

Sudden chest pain
Sudden shortness of breath

If you think you have an emergency, call for medical help right away.

American College of Surgeons

http://www.facs.org/

Society of Thoracic Surgeons

http://www.sts.org/

Canadian Lung Association

http://www.lung.ca/

Health Canada

http://www.hc-sc.gc.ca/index_e.html/

A patient’s guide to lung surgery: recovering at the hospital. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-recoveringinthehospital.html. Accessed March 9, 2010.

A patient’s guide to lung surgery: recovering at home. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-recoveringathome.html. March 9, 2010.

A patient’s guide to lung surgery: when to call the doctor. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/lpg-thoracoscopy-whentocallyourdoctor.html. Accessed March 9, 2010.

Pulmonary lobectomy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated November 2009. Accessed March 8, 2010.

Robot-assisted laparoscopic procedures. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated December 2009. Accessed March 8, 2010.

Robot-assisted thoracic procedures. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated December 2009. Accessed March 8, 2010.

Video-assisted thoracic surgery. Harvard Health Publications website. Available at: http://www.health.harvard.edu/diagnostic-tests/video-assisted-thoracic-surgery.htm. Accessed March 8, 2010.

Video-assisted thorascopic surgery (VATS). Rush University Medical Center website. Available at: http://www.rush.edu/rumc/page-1160429783340.html. Accessed March 8, 2010.

Video-assisted thoracoscopic surgery (VATS). Mayo Clinic website. Available at: http://www.mayoclinic.org/video-assisted-thoracic-surgery. Accessed March 8, 2010.

6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last reviewed June 2012 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.