What is the Video-Assisted Thoracic Surgery (VATS) procedure used for?

Video-Assisted Thoracic Surgery (VATS) Procedure

Video-Assisted Thoracic Surgery (VATS) is primarily used for the surgical management of lung cancer and other thoracic conditions, offering significantly less postoperative pain than open surgery while providing similar long-term results. 1

Primary Indications for VATS

VATS is indicated for:

• Lung cancer resection:

  • Early-stage non-small cell lung cancer (NSCLC), particularly clinical stage I with no lymph node metastasis 2
  • Lobectomy, segmentectomy, and wedge resections 3
  • Diagnostic procedures before proceeding with standard resection to detect unsuspected causes of irresectability 1

• Mediastinal staging:

  • Accessing mediastinal lymph nodes for biopsy and staging 1
  • Systematic lymph node dissection during lung resection 1, 3

• Other thoracic conditions:

  • Management of pleural infections 3
  • Pleural and mediastinal biopsies 4
  • Treatment of pneumothorax 4
  • Pleurectomy 4

Advantages Over Traditional Thoracotomy

VATS offers several significant benefits:

• Reduced mortality: 35/1000 vs 47/1000 patients with traditional thoracotomy 3
• Fewer complications: 152/1000 vs 197/1000 patients 3
• Shorter hospital stays: Median 4-5 days vs 6 days for open procedures 1, 3
• Less postoperative pain: Significantly reduced compared to thoracotomy 1, 3
• Shorter chest tube duration: Median 3 days vs 4 days 3
• Fewer blood transfusions: 2% vs 5% with traditional thoracotomy 3

Patient Selection Considerations

VATS is particularly beneficial for:

• Elderly patients: The less invasive nature makes it particularly suitable for older patients 1
• Patients with comorbidities: Lower complication rates (28% vs 45%) compared to open procedures 1
• Early-stage lung cancer patients: Particularly those without extensive pleural adhesions 3
• Patients with good pulmonary function: Ideal candidates for uniportal VATS 3
• Patients without previous thoracic surgery: Better outcomes in this population 3

Technical Aspects

When performing VATS:

• Oncological principles must be followed:

  • Individual division of vessels and bronchus of the target lobe
  • Systematic lymph node dissection
  • Minimal manipulation of lymph nodes to prevent capsule rupture 3, 2

• Surgical approaches:

  • Conventional multiport VATS (multiple small incisions)
  • Uniportal VATS (single incision) - safe and effective alternative with potentially less pain 3, 5

Clinical Outcomes

VATS has demonstrated:

• Equivalent oncological outcomes to open thoracotomy 6
• Lower perioperative morbidity compared to open procedures 1, 4
• Very low complication and mortality rates making VATS procedures considered safe and effective 4
• Particular benefit for elderly patients with significantly lower rate of complications (28% versus 45%) 1

Potential Complications

The most common complications include:

• Prolonged air leak
• Bleeding
• Infection
• Postoperative pain
• Port site recurrence
• Need for conversion to thoracotomy 4

Important Considerations

• Referral to high-volume centers is recommended for elderly patients as outcomes are associated with surgical expertise 1
• Pneumonectomy should be avoided in elderly patients due to higher risk of postoperative morbidity and mortality 1
• Multimodal pain management approach is recommended, including regional analgesia followed by systemic analgesia 3

VATS has evolved from being primarily a diagnostic tool in the 1990s to becoming the standard approach for many thoracic procedures, with expanding indications to include more advanced and complex operations 7, 6.