Thoracoscopic Surgery?

What is Thoracoscopy?

Thoracoscopy is the visual examination of the chest cavity, pleura, pericardium, lymph nodes and thymus through a telescope (a thoracoscope). Thoracoscopy can also be used for certain surgical procedures. When it is used for surgery, the procedure is often referred to as video-assisted thoracoscopic surgery (VATS).

Purpose of the Thoracoscopy

  • To visually inspect the lungs, pleura, or mediastinum for evidence of abnormalities.
  • To obtain tissue biopsies or fluid samples from the lungs, pleura, or mediastinum in order to diagnose infections, cancer, and other diseases.
  • Used therapeutically to remove a portion of diseased lung tissue (wedge resection).
  • To evaluate patients with pulmonary disease or abnormalities of the pleura (flimsy layer surrounding the lungs) and pericardium (flimsy layer surrounding the heart). To obtain a tissue sample (biopsy) for further evaluation and to diagnose inflammation, infection, fibrosis and cancer.
  • As a minimally-invasive method to perform certain types of surgery, such as pericardiectomy/ cervical sympathectomy.
Video Assisted Thoracoscopic Surgery

(VATS)

Video-assisted thoracoscopic surgery (VATS) is a surgical procedure used in the chest and lungs. It is a type of 'keyhole' surgery where only very small incisions are made to the body. VATS uses a special instrument called a thoracoscope. This is a thin, tube-like instrument which has a camera built into the end. The camera feeds pictures from the chest on to a screen. This allows your surgeon to look inside the chest and lungs.

Procedure

  • The surgeon makes two or three small incisions in the chest wall near the ribs. These holes are known as ports and are usually about two cm long.
  • The surgeon then inserts the thoracoscope through one hole. The camera in the thoracoscope feeds video images to a computer screen, allowing the surgeon to see inside the chest.
  • The surgeon will also insert special surgical instruments into the other incisions. These instruments can be used to remove tissue which may have been seen on an X-ray, or fluid found in the chest.
  • Once the surgery has finished, the instruments are removed and the incisions are closed, usually with stitches.

Advantages

  • Minimal postoperative pain
  • Shorter hospital stay and early return to work and normal activities.
  • Excellent cosmetic results.

Indications for VATS

VATS is used in both diagnostic and therapeutic pleural, lung, and mediastinal surgery. Specific indications include the following:

  • Stapled lung biopsy: A lung biopsy removes a small piece of lung tissue that can be looked at under a microscope by the pathologist or sent to a microbiological laboratory for culture to identify the organisms causing a disease.
  • Lobectomy or pneumonectomy: Pneumonectomy is a surgical procedure in which an entire lung is removed. Lobectomy is a common surgical procedure that removes one lobe of the lung that contains cancerous cells
  • Resection of peripheral pulmonary nodule
  • Evaluation of mediastinal tumors or adenopathy: Mediastinal tumors are benign or cancerous growths that form in the area of the chest that separates the lungs. Adenopathy is the enlargement of lymph nodes anywhere in your body.
  • Pleural biopsy: A pleural biopsy is a procedure in which a sample of the pleura (the membrane that surrounds the lungs) is removed with a special biopsy needle or during surgery to determine if infection, cancer, or another condition is present.
  • Bullectomy: Bullectomy is the surgical removal of a bulla, which is a dilated air space in the lung parenchyma measuring more than 1 cm.
  • Treatment of recurrent pneumothorax: A pneumothorax refers to a collection of air in the pleural cavity (between the lung and the chest wall) resulting in collapse of the lung on the affected side.
  • Management of loculated empyema: Empyema is a collection of pus (dead cells and infected fluid) inside a body cavity.
  • Pleurodesis of malignant effusions: Pleurodesis is a well-accepted, palliative therapy for patients with recurrent malignant pleural effusion.
  • Repair of a bronchopleural fistula: A bronchopleural fistula is a communication between the pleural space and the bronchial tree.
  • Chest trauma (mainly diaphragmatic injuries)
  • Pericardial window: A pericardial window is a cardiac surgical procedure to create a fistula - or "window" - from the pericardial space to the pleural cavity.
  • Sympathectomy: Sympathectomy is a surgical procedure that destroys nerves in the sympathetic nervous system.
  • Truncal vagotomy: Vagotomy is an essential component of surgical management of peptic (duodenal and gastric) ulcer disease (PUD).
  • Thymectomy: Thymectomy is an operation to remove the thymus gland. Thymectomy is usually indicated when thymoma are present in the thymus.

Frequently Asked Question

Thoracoscopy is a medical procedure involving internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic cavity.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used to diagnose and treat problems in your chest.

Surgeons use the video-assisted thoracoscopic surgery technique to perform a variety of operations, such as:

  • Biopsy to diagnose lung cancer, mesothelioma and other chest cancers
  • Esophagus surgery (esophagectomy)
  • Hiatal hernia repair
  • Lung surgery, such as surgery to treat lung cancer and lung volume reduction surgery
  • Procedures to remove excess fluid or air from the area around the lungs
  • Surgery to relieve excessive sweating (hyperhidrosis)
  • Surgery to relieve gastroesophageal reflux disease
  • Thymus gland removal surgery (thymectomy)
  • Thoracoscopy requires general anaesthesia, and thus carries the associated risks.
  • Rare complications include excessive bleeding, infection, perforation of the diaphragm, and pneumothorax (leakage of air outside the lungs and into the pleural cavity, resulting in a collapsed lung).

In most patients, a VATS lung resection will have minimal impact on their respiratory breathing.

Yes, but it’s intentional. We stop pumping air into the lung to allow the lung to be in a resting state during a VATS procedure in order to provide complete visualization of the intrathoracic cavity, and ensure success. Once the procedure is complete, the air is allowed re-enter the lung, allowing it to naturally re-expand. Upon completion of surgery, a chest tube is inserted to facilitate a return to the natural state.

There are no side effects of the surgery.

Generally, you can be discharged on the next day of the surgery.

In general, plan to take about one week off from work.

Mostly the procedure is covered under most medical insurance plans. Please confirm in your policy documents.

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