The diagnosis and treatment of lung diseases and many diseases in the thorax are made with video-assisted thoracoscopic surgery [VATS (video-assisted thoracoscopic surgery)], also called closed surgery and minimally invasive surgery.
In the VATS procedure, every corner of the thorax is visualized with the help of a camera. It can be magnified and reflected on the monitor and observed by the surgeon and the whole team on the patient's side.
One or more small incisions are made in the chest wall, that is, between the ribs. Through the other incisions, we perform the surgery by entering the chest cage with surgical instruments.
What is Single Port VATS Method?
VATS, classically, is performed through 3 incisions (ports). Later, we started to perform major surgeries such as lung cancer through 2 incisions, which is still the most preferred.
But recently, we have started to do Single Port VATS, that is, from a single entry. The camera and surgical instruments are inserted through a single incision, and the operation is performed. We safely perform major surgeries such as lung cancer through a single incision.
We generally want this incision to be 2 cm. Sometimes, when the mass is huge, we remove it with the help of a bag called an endo bag, and sometimes we enlarge this incision. A chest tube is placed in the chest to allow lung swelling after surgery and to prevent fluid accumulation. This tube is removed before discharge when the air leakage stops and the fluid formation decreases.
Figure 1: Single Port VATS; Both the camera and surgical instruments are inserted through a single port.
The advantages of Minimally Invasive VATS are as follows:
- The patient satisfaction rate is high, and it is a highly reliable method.
- Compared to open surgery, the incisions are relatively small and have the advantage of a better cosmetic appearance.
- It is a less painful and much more comfortable surgical method than open surgery.
- Since there is less pain, the patients use fewer painkillers
- Fewer cardiac complications (such as atrial fibrillation)
- It is more comfortable in terms of respiratory function
- Fewer complications (such as pneumonia)
- The immune system is less affected.
- The length of stay in the hospital is short, and a rapid return to everyday life.
- VATS provides comfort for the patients not only after the operation in the hospital but also in the post-discharge period.
- Less chronic pain
- Better and more comfortable in terms of respiratory functions
Due to the abovementioned advantages, it is frequently preferred in thoracic surgery practice today. It stands out as our clinic's most commonly used operation technique.
The Primary Minimally Invasive Surgical Techniques are as follows;
- Surgery with a single port VATS
- Surgery with VATS
- Robotic surgery
VATS - both as diagnostic and therapeutic
Operations that are frequently performed with VATS are;
- Lung cancer surgeries/lung resections (such as lobectomy and segmentectomy)
- Removal of mediastinal masses
- Thymus gland or thymoma (thymus gland masses) surgeries
- Mediastinal cysts
- Nodule Removal
- Metastasis surgery
- in selected cases
- If the number of metastases is too high, open surgery should be preferred.
- Lung biopsy
- Lymph node biopsies
- Lung membrane (pleural) biopsies
- Lung cysts in infants and adults
- Hand sweating surgeries (ETS)
- Pneumothorax surgery
- Bullous lung surgeries
- Lung membrane (pleura) biopsies, surgeries
- Fluid collection in the chest cavity (pleurisy, pleural effusion) surgeries (drainage / pleurodesis)
- Empyema (collection of inflammation in the chest cavity) treatment
- Some infective lung diseases
- Surgery for fluid accumulation in the pericardium (pericardial window opening) and pericardial biopsies
- Diaphragm surgery (plication/defect repair)
- Chest wall deformities (pectus excavatum)
Video 1: Single Port VATS Left lower lobectomy and mediastinal lymph node dissection video in a carcinoid tumor of the left lower lobe
Video 2. Removal of mediastinal mass with Single Port VATS
Video 3: Lung nodule removal with Single Port VATS
Video 4. Performing pleural biopsy with Single Port VATS
However, in some cases, there may be effects that prevent the use of Closed Surgery:VATS technique in these diseases. Such sections are preferred for open surgery or can be converted to open surgical technique during surgery.
There should be no hesitation in revealing such sections, otherwise some vital problems may arise. These types of disabling consequences are usually adhesions that do not leave room for previous use of death thorax cameras and surgical instruments such as scanner scanning operations, scanning measurements or radiotherapy. Some cells are difficult to intubate.
Picture 2: Open surgery (Thoracotomy)
Conclusion
VATS technique is applied very efficiently and safely by experienced hands in current thoracic surgery practice. It has many advantages over open surgery. In our clinic, thoracoscopic surgeries have been performed at a high rate and safely for ten years.
Frequently Asked Questions About Single Port Vats and Thoracoscopic Surgery
The surgeon decides the application of the Single Port VATS method according to the disease and the course of the disease. Although the Single Port VATS method is generally used in treating lung cancer, its application area is not limited to this. Today, many patients with a single port VATS indication for thoracic surgery enjoy the benefits of this method.
Operations that are frequently performed with VATS are;
- Lung cancer surgeries/lung resections (such as lobectomy and segmentectomy)
- Removal of mediastinal masses
- Thymus gland or thymoma (thymus gland masses) surgeries
- Mediastinal cysts
- Nodule Removal
- Metastasis surgery
- Lung biopsy
- Lymph node biopsies
- Lung membrane (pleural) biopsies
- Lung cysts in infants and adults
- Hand sweating surgeries (ETS)
- Pneumothorax surgery
- Bullous lung surgeries
- Lung membrane (pleura) biopsies, surgeries
- Fluid collection in the chest cavity (pleurisy, pleural effusion) surgeries (drainage / pleurodesis)
- Empyema (collection of inflammation in the chest cavity) treatment
- Some infective lung diseases
- Surgery for fluid accumulation in the pericardium (pericardial window opening) and pericardial biopsies
- Diaphragm surgery (plication/defect repair)
- Chest wall deformities (pectus excavatum)
After Thoracoscopic Surgery with Single Port VATS, the patient's hospital stay is much shorter than normal surgical operations, and the patient can return to his daily life much faster. During this period, the patient should follow the advice and warnings recommended by the doctor. The recommendations that the patient should follow after the operation are as follows:
- The patient should not lift heavy weights for approximately 2-3 weeks,
- Should do light and non-strenuous exercises as recommended by the doctor,
- The diet program recommended by the doctor should be strictly followed and only fed in this way,
- All medicines prescribed by the doctor should be used under the doctor's instructions,
- Sleep deprivation should be avoided, and the patient should maintain sleep patterns,
- The doctor should regularly schedule check-ups.
- In case of following these recommendations, return to everyday life will be quick.
In Single Port VATS operations, information about the operation will vary according to the disease and the course of the disease. Here, factors such as the physician's experience who will perform the surgical intervention and the severity of the procedure are decisive for the surgery duration. Usually, a Single Port VATS operation takes between 1 and 3 hours. We inform the patient before the surgery about the duration of the surgery. Patients should do the following before the surgery:
- Cessation of the use of anticoagulants,
- Quit smoking,
- Doing light exercises daily,
- Stop food intake 12 hours before the operation.
- Paying attention to the warnings mentioned above helps reduce surgical complications.
If the operation is performed with closed methods, the patient won't need to be hospitalized in the intensive care unit.However, if a lobectomy is performed, we may prefer hospitalization in the intensive care unit for one day, as a precaution and for a good follow-up.
It may vary according to the patient's age and the disease's condition. This period varies between 1-5 days. The patient is usually discharged within 2 or 3 days unless they have undergone an open operation.
After the Single Port VATS procedure, the patient returns to everyday life in approximately two weeks. Of course, it may vary depending on factors such as the extent of the operation and the age and physical characteristics of the patient. Sometimes it can take 3-4 weeks. If the patient strictly follows the doctor's recommendations and stays away from activities that tire him out, returning to everyday life will be shorter.