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Video-assisted thoracoscopic surgery (VATS)

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon.

This page was reviewed on September 26, 2022.

A video-assisted thoracoscopic surgery, or VATS, is a surgical procedure that allows your doctor to perform minimally invasive surgery of your lungs and structures within the chest cavity.

The procedure is performed using a thoracoscope, a thin, narrow tube with a tiny camera on the end. The thoracoscope lets your surgeon see inside your body to perform surgery for diagnostic or therapeutic purposes.

If you’re scheduled to have a video-assisted thoracoscopic surgery, here’s what to expect from the procedure.

When is video-assisted thoracoscopic surgery used?

VATS is used in a range of situations. Common reasons for the procedure include:

  • Looking into the chest to diagnose the source of a health concern, such as the presence of lesions between the chest wall and the lung
  • To diagnose health issues, such as lung cancer and mesothelioma
  • To treat cancer, including lung cancer and cancers of the thymus gland and esophagus
  • To treat fluid in the lungs, a medical condition called effusion 

VATS may also be used for other reasons, such as treating a mediastinal mass or performing lymph node biopsies.

VATS is beneficial for patients because it offers a faster recovery and less pain after surgery. Your doctor can explain the risks and benefits to help you make the decision that’s right for you.

Types of VATS procedures

Rather than a single, large incision, like a traditional open surgery would include, a VATS procedure utilizes a few smaller incisions for inserting the doctor’s tools. VATS is considered minimally invasive, and it involves different types of procedures.

VATS lobectomy: A lobectomy is the surgical removal of one or several lobes (sections) of the lungs. Lobectomies are commonly used treatment options for non-small cell lung cancer.

VATS wedge resection: A VATS wedge resection is usually used to diagnose the cause of lung nodules or to address cancers that have spread from other parts of the body. During this procedure, doctors remove a small, triangular-shaped part of the lung (a wedge).

VATS procedure for pleural effusion: Sometimes fluid builds up within the pleural space, which is known as pleural effusion. The VATS procedure is able to drain this fluid out of the pleural cavity and perform procedures to treat/prevent effusion recurrence.

VATS biopsy: A biopsy is a procedure where a small amount of tissue is removed from your body so that it may be examined more closely for cancer cells. If cancer is suspected in your chest or lungs, a VATS biopsy may be used.

How to prepare

Before the procedure, your doctor can walk you through what to expect—including the benefits, potential side effects and recovery process. Other things to keep in mind: tell your care team about each type of medication you’re currently taking, including over-the-counter drugs and supplements. Some medications, like blood thinners, might need to be stopped for a short time before the VATS to reduce the risk of bleeding.

It can help to arrange for a friend or loved one to drive you home after you’ve been discharged. Most patients will stay in the hospital for a few days after VATS.

What to expect during the procedure

Before the VATS begins, you’ll be placed under general anesthesia, so that you’ll be asleep during the procedure and won’t feel any pain. Then, a breathing tube is inserted so that you can breathe normally.

The surgeon will position you on your side and will make several tiny cuts on your chest, near your ribs. The thoracoscope is inserted into these incisions so that your doctor can see inside your body and perform the procedure without spreading or breaking the ribs. A chest tube is also inserted before you wake up from anesthesia to help with breathing and will be removed a few days later before you’re discharged.

Even after you’re recovering at home, it might still take some time before you feel like yourself again, so try to rest and follow your doctor’s aftercare instructions, which will be provided to you before you leave.

Compared to open surgery, which is a traditional way of doing this procedure, VATS patients tend to recover faster and have fewer complications. This is because the doctor doesn’t need to cut the ribs or sternum.

Recovery from a VATS procedure

After a VATS procedure, it’s normal to feel sore at your incision sites. These will be closed with either stitches or staples, and your doctor can remove them one to two weeks later during a follow-up appointment.

Once you get home, follow your doctor’s aftercare instructions, taking medication as required. You may feel tired for the first few weeks, including requiring naps.

It's important to walk at least three times a day as long as your doctor approves it. If you don't walk, the chance of developing pneumonia or blood clots increases significantly. However, you should avoid heavy lifting or strenuous exercise until your doctor tells you it’s safe.

One of the most common complaints after any surgery is constipation, due to pain medications and general anesthesia. With constipation, you may feel bloated and you may not be able to take deep breaths. You may become nauseated or vomit as bloating worsens. Also, because of pain in the chest when you strain, you may not be able to successfully have a bowel movement. If you don't have a bowel movement within three to four days after surgery, call your care team.

If you're feeling unwell during your recovery or have any questions about aftercare instructions, call your care team right away.

Risks

Although VATS is a safe procedure, there is always a risk of harm with any surgery, depending on the extent of the surgery. A few risks associated with VATS include:

  • Air leaking from the lungs
  • Infection
  • Fever
  • Blood clots, which can lead to stroke or pulmonary embolism
  • Excessive bleeding
  • Pneumonia
  • Lung collapse
  • Anesthesia-related complications
  • Damage to organs near the incision site
  • Nerve damage
  • Thick pus within the chest cavity
  • Irregular heart rhythm
  • Heart attack

While you’re recovering, your care team will closely monitor you for any side effects. Once you get home, always call your care team right away if you’re feeling unwell, especially with breathing difficulties.

Side effects and risks may vary based on your age, overall health and the reason you’re having a VATS procedure. Before surgery, speak with your doctor about potential side effects.

Results

Depending on the reason for your VATS, additional surgery might be required. For example, if a biopsy was done during VATS, the biopsy results will dictate what further treatment is needed.

After VATS, you’ll have a series of follow-up appointments with your doctor, who will update you on the results. It’s normal to feel worried about the results of your procedure, so always ask your care team if you’re unsure about something they’ve said or if you need further clarification.

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