From the Guidelines
VATS is needed for patients with clinical stage I NSCLC, as a minimally invasive approach is preferred over a thoracotomy for anatomic pulmonary resection, especially in experienced centers 1. When considering the use of Video-Assisted Thoracic Surgery (VATS), it's essential to weigh the benefits and risks, particularly in terms of morbidity, mortality, and quality of life. VATS is commonly indicated for:
- Lung biopsies to diagnose suspicious nodules or masses
- Lung resections for early-stage lung cancer (lobectomy or wedge resection)
- Treatment of recurrent pneumothorax (collapsed lung)
- Drainage of pleural effusions or empyema that cannot be managed with simple chest tube placement
- Diagnosis and treatment of pleural diseases
- Mediastinal mass biopsies
- Sympathectomy for hyperhidrosis
- Treatment of certain esophageal disorders The procedure involves making small incisions in the chest wall, allowing surgeons to visualize and operate within the thoracic cavity with minimal tissue trauma. VATS offers significant advantages over open procedures, including:
- Less postoperative pain
- Shorter hospital stays (typically 2-4 days versus 5-7 days for open procedures)
- Faster recovery
- Reduced blood loss
- Lower risk of infection
- Smaller, less visible scars However, VATS may not be suitable for patients with extensive pleural adhesions, very large tumors, or those requiring complex reconstructions, where conversion to open thoracotomy might be necessary. In elderly patients, VATS has been shown to be a viable option, with reduced postoperative morbidity and shorter hospital stays compared to open procedures 1. It's also important to consider the patient's overall health, performance status, and presence of comorbidities when deciding on the use of VATS. In terms of specific conditions, VATS can be used for staging and palliation in malignant pleural mesothelioma, and has been shown to improve control of pleural effusion and quality of life in these patients 1. Ultimately, the decision to use VATS should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances. Key benefits of VATS include:
- Reduced postoperative complications
- Shorter hospital stays
- Improved quality of life
- Minimally invasive approach
- Suitable for elderly patients and those with comorbidities
- Can be used for a range of conditions, including lung cancer, pleural diseases, and esophageal disorders.
From the Research
Indications for VATS
VATS (Video-Assisted Thoracic Surgery) is needed in the following situations:
- Early-stage non-small-cell lung cancer (NSCLC) treatment, as it has become a standard approach for this condition 2, 3, 4
- Anatomic resection of clinical stage I lung cancer, as it results in fewer complications compared to thoracotomy 5
- Lobectomy, as VATS shows equivalent oncological outcomes as thoracotomy and has lower morbidity, shorter chest tube duration, and shorter hospital stay 2, 4
- Advanced cases and previously contraindicated complex procedures such as bronchoplasty and chest wall resection, as VATS has recently been applied to these situations 4
- Uniportal VATS (UniVATS) for non-small cell lung cancer, as it has emerged as a less invasive approach with benefits compared to multiport VATS 6
Benefits of VATS
The benefits of VATS include:
- Reduced postoperative complications, such as atelectasis and blood transfusions 2
- Shorter postoperative length of stay 2, 5
- Lower morbidity and mortality rates compared to thoracotomy 2, 5
- Equivalent oncological outcomes as thoracotomy 2, 4
- Feasibility for numerous and complex procedures for lung cancer diagnosis and treatment 6