This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Occasionally we have questions from our community members about video-assisted thoracic surgery, also known as “VATS.” This is a surgical procedure used to diagnose and treat problems in the chest area when cheaper, less invasive options have not provided answers. Surgeons insert a thin instrument with a camera called a thoracoscope into a small incision in a patient’s chest. The scope allows the surgeon to view the inside of the chest. Being able to see inside the chest helps the surgeon guide and perform procedures.¹

VATS helps health care providers to

• Establish diagnoses or treat conditions, including infection or other processes, which involve the lining of the lung.
• Take tissue samples and examine them under a microscope.
• Remove small parts of the lung for diagnostic purposes.
• Remove a large section of the lung to treat select lung conditions or infections.²

Before a VATS procedure. Patients will be given instructions on what to do before the procedure by their surgeon’s office. Fasting before surgery is required. The patient may be asked not to take certain medications, vitamins, and herbal supplements before the procedure.

Testing such as an EKG (a test that monitors the electrical activity in your heart), chest X-ray, CT scan, PET scan (positron emission tomography), PFT (pulmonary function test), and blood tests may be ordered before the procedure.

Before the procedure, ask about the weekend/ holiday contact information for your doctor’s office.

What to expect. The VATS procedure is done in a hospital or an outpatient surgical center under anesthesia by specially trained surgeons or pulmonologists. The physician will either make several small incisions or a single incision. He/she will then insert the thoracoscope device, which sends pictures of the inside of the chest to a video monitor. The video images will be used to guide the procedure. The surgeon will insert some small tubes into the chest once the procedure is completed. These chest tubes allow for the drainage of any fluid or air. Any tissue samples will be sent to a lab for testing. The tissue may be tested for signs of infection or disease.

Benefits of VATS include:

• Smaller and fewer incisions than the traditional open surgery known as a thoracotomy.
• Shorter hospital stays.
• Less pain and scar tissue after the procedure
• Less need for a blood transfusion
• Lower chance of infections and other post-op problems

What are the risks of VATS?

• Blood loss
• Blood clots and strokes
• Collapsed lung (pneumothorax) or atelectasis (partially collapsed lung)
• Damage to nearby glands, organs, nerves, or blood vessels
• Hypoxemia (low blood oxygen)
• Abnormal heart rhythms
• Infections, Pneumonia

After a VATS procedure. You may be asked to stay in the hospital for a few nights after the procedure. Your health care team may give you oxygen through a nasal cannula (a small tube in your nose after the procedure). Antibiotics may be ordered to prevent infection.
Writer’s note: Ask your health care provider if they plan on prescribing pain medicines prior to getting the chest tubes removed. After having the procedure twice, I feel that this was the most uncomfortable part of the process.

At-home recovery. You may be responsible for changing small dressings, taking antibiotics, pain relievers, and/or other medications as ordered by your healthcare provider. Wearing compression socks is usually recommended. Compression socks can prevent the development of blood clots in the leg especially if used after surgery or when you may be inactive for a while.³

Staying home from work or school, resting and not lifting anything heavy, and not driving for a period of time may be recommended. You should call your healthcare provider if you experiencesigns of infection (such as redness or yellow discharge or swelling at the incision site), fever, or shortness of breath. If you experience chest pain, difficulty breathing, or are coughing up blood, seek emergent care immediately.

Ask your health care provider how and when you can become active. Often walking within the hospital unit and around your home after discharge is recommended. Movement may reduce the chance of complications after the procedure. I am so grateful that this less invasive procedure exists and that they do not have to perform the more invasive open lung surgery of the past which carries much greater risks.

References

1. Video-Assisted Thoracic Surgery (VATS). Cleveland Clinic. Published Nov 9, 2022. Date accessed, April 17, 2023. https://my.clevelandclinic.org/health/treatments/17617-video-assisted-thoracic-surgery-vats
2. Video-assisted thoracoscopic surgery (VATS). Mayo Clinic. Date published Nov 16, 2022. Date accessed April 17, 2023. https://www.mayoclinic.org/tests-procedures/video-assisted-thoracic-surgery/about/pac-20384922
3. Mayo Clinic Q and A: Tips for using compression stockings. Mayo Clinic News Network. Published July 31, 2017. Date accessed April 28,2023. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-tips-for-using-compression-stockings/

Other references:

Video-Assisted Thoracoscopic Surgery | Johns Hopkins Medicine, Date published, August 14, 2019. Date accessed April 19, 2023. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/video-assisted-thorascopic-surgery

Video Assisted Thoracic Surgery, VATS, YouTube, Maimonides Medical Center, Brooklyn, NY. Date published, June 01, 2012. https://www.youtube.com/watch?v=KoBw_-xj68E