Video Assisted Thoracoscopic Surgery (VATS) in Delhi, India

Video-assisted thoracoscopic surgery is a form of minimally invasive surgical procedure performed by the surgeon to diagnose as well as treat several conditions of the chest. This procedure is performed with the help of an instrument called a thoracoscope, a thin and narrow tube with a camera placed at the end. It is usually performed in patients to manage lung, mediastinal, diaphragmatic and pleural pathology. Since this is a minimally invasive surgery, it involves very tiny incisions, no rib spreading, and no cutting of muscles compared to the traditional open surgical approach. This surgery has led to a revolution in the treatment and management of various chest diseases. This form of surgery is very safe for the elderly and frail patients.

Why Is Video Assisted Thoracoscopic Surgery Done?

Surgeons often use VATS for diagnostic and therapeutic procedures of the chest. It may involve removing either a part or an entire organ because of infection, cancer, traumatic injury, etc.

Common chest conditions where VATS can be used are as follows:

• Lung cancer treatment
• Lung abscess drainage or resection.
• Removal of fibrous tissue around the lung (decortication).
• Lung infections like Bronchiectasis and fungus of the lung (Aspergilloma).
• In the drainage and prevention of recurrent pleural effusion (fluid outside lungs).
• In the drainage of empyema (pus outside lungs) or haemothorax (blood outside lungs).
• Pneumothorax (air outside lungs).
• Paralysis of the diaphragm (plication of the diaphragm).
• Hyperhidrosis (excessive sweating of palms).
• Paraspinal tumors and abscesses.
• Treatment of Myasthenia Gravis (thymectomy).
• Thymoma and thymic carcinoma.
• Lung parenchymal biopsy (e.g. for ILD ).
• Mediastinal lymph node biopsy or resection.
• Wedge resection for Lung nodules.
• Lung metastatectomy.
• Bullectomy for unruptured, ruptured or infected lung bulla.
• Lung volume reduction surgery in severe emphysema.
• Treatment of oesophageal cancer
• Treatment of oesophageal leiomyoma or oesophageal duplication cyst.
• Resection of bronchogenic cyst.
• Pericardial window drainage for recurrent pericardial effusion.
• Treatment of pulmonary sequestration.
• Excision of benign mediastinal masses like neurogenic tumours.

Types of Video Assisted Thoracoscopic Surgery (VATS)

The following are some examples of common types of VATS procedures:

• VATS lobectomy: This is the most commonly used treatment option for cancers of the lung, bronchiectasis, aspergilloma, destroyed lung, etc.
• VATS drainage and decortication: In order to drain out the fluid (water, pus, blood, etc) from the pleural cavity, this procedure is generally performed. It also helps in the expansion of collapsed lungs and the prevention of the recurrence of pleural effusion.
• VATS wedge resection: This procedure is carried out to diagnose the underlying causes of lung nodules and manage cancers that usually spread from other parts of the body (pulmonary metastatectomy). In this procedure, the surgeons resect a small, triangular-shaped part of the lung, which resembles the shape of a wedge.
• VATS biopsy: It involves the removal of a small amount of tissue from the lungs or mediastinum or pleura for examination as well as the detection of cancer cells or infections like TB.
• VATS bullectomy: It involves the removal of a lung bulla which has ruptured and is causing air leak or compression of the underlying lung or is infected. It is usually complemented with pleurodesis.
• VATS thymectomy: It involves the removal of the whole thymus gland for myasthenia gravis or for tumours of the thymus gland like a thymoma.

Patient Preparation Before VATS

Generally, it includes:

⮚ Stopping the consumption of blood thinners

⮚ Avoiding smoking and drinking

⮚ Regular exercising

⮚ Avoid consumption of meals after midnight, before the procedure.

Before the Procedure

Apart from the routine blood tests, additional scans are recommended by the surgeon on a case to case basis. These are as follows:

⮚ Chest X-ray to examine heart and lungs.

⮚ Chest CT-scan

⮚ PET to look for cancerous tissue.

⮚ Pulmonary function test to check the efficiency of the lungs.

⮚ ECG to check heart rhythm.

Procedure Details

Anaesthesia and breathing tube insertion: Before the start of VATS, the patient is administered general anaesthesia so that they remain unconscious during the procedure and don't feel pain. After that, a breathing tube is inserted to restore a normal breathing pattern.

Positioning the patient and making incisions: The surgeon positions the patient by making them lie on their side and makes small incisions on the chest near the ribs.

Thoracoscope insertion and visualization: Afterward, an instrument called a thoracoscope is inserted through these incisions so that the surgeon can visualize the inside of the body and perform the procedure further without any possible damage of breaking the ribs.

Instrument placement and image assistance: The surgeon puts other small instruments through these small incisions required for the procedure. The thoracoscope sends images of the entire thorax to the video screen, which helps in the removal of the diseased part.

Finalization: Once the procedure is over, the incisions are closed with removable stitches. The chest tube (which helps in the restoration of breathing, and drainage of fluid & air) will be removed a few days before getting discharged.

Robotic VATS: In certain cases, the doctors use of advanced robotic technology to carry out this surgery. The doctors view the images obtained from a robotic thoracoscope and accordingly guide the robotic surgical device docked on the patient to extract the tissue or diseased organ.

Benefits of VATS

• Shorter hospital stay
• Lesser risk of blood loss
• Lower risk of infections
• Quick recovery of respiratory functions
• Less scarring
• Less amount of pain
• Resumption of normal activities more quickly
• Better cosmesis

Risks of VATS

Although VATS is a safe procedure, there is always a certain amount of risk involved depending on the type of procedure involved. The following risks are involved with this procedure:

• Fever
• An excessive amount of bleeding
• Pneumonia
• Infection
• Damage to the nerves
• Blood clots leading to stroke
• Leakage of air from the lungs
• Pus within the chest cavity
• Organ damage near the site of infection
• Irregular heart rhythm
• Post-anesthetic complications
• Heart attack
• Shock

Recovery at Home after VATS

This includes the following:

⮚ Regular change of surgical dressings as adviced.

⮚ Consumption of antibiotics and painkillers as advised by the doctor.

⮚ Avoid driving for a stipulated amount of time.

⮚ Avoid lifting weights for a particular period as suggested by the doctor.

Outlook of VATS

The outlook for this surgery depends on the particular thoracic disorder, the overall health condition of the patient, and the success of the treatment. The outlook of this surgery varies from person to person. VATS is a form of minimally invasive procedure with a faster recovery as compared to open-chest surgery.

Review

Reviewed by Dr. Kamran Ali - Principal Consultant, Thoracic Surgery, Lung Transplant.