Applications for Video-Assisted Minimally Thoracic Surgery

Video-assisted minimally thoracic surgery (VATS) began as early as the late 16th century, according to a 2019 journal article published in the scholarly journal Shanghai Chest. While performing an endoscopic inspection, Tulio Cesare Aranzi funneled sunlight through the nasal cavity using a flask with water. The more modern version of this technology did not show up until the early 1990s, when doctors completed the first VATS lobectomy following several methods of lung resection.

VATS involves taking a small tube (a thoracoscope) and inserting it through a small incision between the ribs. The thoracoscope has a camera attached to the end of it, allowing the physician to view the chest cavity clearly without opening the chest up or spreading the ribs. VATS is used for both therapeutic and diagnostic purposes.

The conditions for which this procedure is used include lung cancer and interstitial lung disease (ILD). In lung cancer cases, VATS is applied during the diagnosis, staging, and treatment, and it is used to remove pulmonary nodules (abnormal growths) to reduce the spread of the disease. ILD, meanwhile, refers to a group of diseases that create fibroids on the lungs, making it difficult to breathe. VATS makes it possible for surgeons to perform scans and biopsies to determine whether there are any fibroids on the lungs without making a large incision.

VATS is also used to view and treat emphysema. As a part of lung volume reduction surgery, an incision is made to admit the thoracoscope for viewing. The surgeon then uses forceps and surgical stapling tools to remove the tissue through two other incisions.

VATS allows surgeons to view the entire lung surface when the patient has a collapsed lung, known as spontaneous pneumothorax. In the case of this particular procedure, patients tend to experience less post-operative pain.

VATS is used to make incisions under the arm in a procedure to remove the thymus gland in cases of myasthenia gravis. Surgeons with more experience might use VATS to perform transcervical thymectomy, which removes the thymus through the lower part of the neck.

Minimally invasive surgery involving VATS also allows for reduced post-operative discomfort. Generally, minimally invasive surgery offers various benefits for surgeons and patients, including faster recovery times and cleaner surgeries on the chest. Furthermore, if the patient needs thoracic surgery sometime in the future, their chest is less compromised.

For surgeons, VATS allows for more flexibility, especially when treating lung cancer. Because the procedure does not expose the patient to unsafe practices when done properly, it enables the surgeon to convert to open surgery if necessary.

Some of the risks of VATS include the patient developing a lung infection, bleeding or clotting, temporary and permanent nerve damage, anesthesia-related complications, and organ damage near areas where the procedure was performed. Other risks that might lead to health complications include the patient experiencing a partially collapsed lung, collection of pus around the chest cavity, pneumonia, abnormal heart rhythm, and shock, as well as air leaking into the area. Outside of these disadvantages, the procedure can be costly, with some researchers stating that it has no commensurate benefits for the patient.