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 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.
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
- 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)
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.
How Long Does VATS Take?
In 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.