Thoracoscopy

1. Video-assisted thoracoscopic surgery (VATS) is a minimal invasive thoracic surgery (MITS).
2. This procedure is used to diagnose and treat the conditions of the chest.
3. Most of the major traditional surgeries that were used to perform with open thoracotomy can now be performed using minor cuts and with video guidance.
4. Minimal invasive surgery procedures provide safe, successful and effective results when the patients are appropriately selected.
5. This technique helps in continued assessments of  the chest region while dealing with cases  for biopsy - lung cancer, hyperhidrosis etc

What will happen if surgery is delayed? 

1. Video-assisted thoracoscopic surgery is performed to manage several conditions, some of which are life-threatening. These conditions include lung cancer or other types of cancer. Delaying this surgery may result in the spread of cancer to other organs. It may reduce the overall chances of survival of patients. Thus, the surgery should not be delayed when the patients have a life-threatening condition.
2. Further, some conditions are not life-threatening. However, they may affect the quality of life. Progression of these conditions may also result in complications. Thus, it should not be delayed if there is an actual need for surgery.

The VATS lobectomy patients were shown to have

1.  Fewer major complications like atrial fibrillation,
2.  Fewer atelectasis, prolonged air leak, pneumonia and renal failure.
3. Duration of chest tube and length of hospitalization are shorter in the VATS lobectomy group.

Why is this procedure done?

The surgeon may use video-assisted thoracoscopic surgery to do a variety of procedures. They are:-

1. Removing lymph node
2. Removing lumps or growth of any tumours from the lungs.
3. Biopsy for diagnosing lung cancer
4. Diagnosing mesothelioma (cancer of thin tissue lining lungs and abdomen) and another type of chest cancer
5. Removing extra fluid and gas from the area around the lungs
6. Repairing hiatal hernia (Bulging of the upper part of the stomach into the chest cavity)
7. Relieving the condition of excessive sweating
8. Treating a certain type of esophageal disorders.
9. Thymectomy (removal of the thymus gland)

The treatment procedure of Video-assisted thoracoscopic surgery 

1. The standard procedure of Video-assisted thoracoscopic Surgery includes three to four minor cuts in a triangular configuration, for inserting the thoracoscope and other instruments. 
2. Anaesthesiologists will then inject a dose of general anaesthesia into the patients. Anaesthesia is given in a supine position (A position of laying with the face of the patient-facing toward the sky and back toward the ground).
3. A thin tube is inserted into the throat of the patient for assisting with breathing during the surgery.
4. After this, the patient is positioned in a lateral decubitus position withholding arms over the head. 
5. After this, three cuts are made to your chest. These three cuts together make a triangular configuration.
6. Then the surgeon may insert a thoracoscope and other instruments through the cuts. It is inserted through each incision to ensure the path for instruments.
7. After creating all three ports, instruments are inserted, and surgeons remove or repair the damaged part.
8. After the surgery, the cuts are closed using suitable sutures and bandages.
9. Surgeons may insert a small thin tube in the chest cavity. These tubes are known as chest drains. This tube drains any excess liquid or gas into the chest cavity to leak out.
10. What to expect before Video-assisted thoracoscopic Surgery? 7, 8
11. Before the procedure of Video-assisted thoracoscopic Surgery, your doctor may check your overall health to confirm how good your lungs are working and how well are you to undergo the process. You may get:-
12. X-ray of the chest.
13. Blood test.
14. Lung test.
15. The doctor may advise an electrocardiogram to check the activity of the heart.
16. Imaging tests of the chest such as CT scan and PET scan
17. Your doctor may also ask you to:-
18. Stop smoking
19. Stop taking certain medicines like blood thinners.
20. Include some exercise in your daily routine.
21. Stop eating the night before the surgery.
22. Perform breathing exercises.
23. What to expect on the day of Video-assisted thoracoscopic Surgery? 9, 10
24. Reach the hospital premise at the scheduled time.
25. Do not wear jewellery and makeup while going to the hospital for surgery.
26. Clothing that you wear to the hospital should be comfortable and loose-fitting. In addition, they should also be comfortable to wear after the surgery procedure.
27. Do not wear any metal piercings, contact lenses or glasses to the hospitals.
28. Surgeons will place an Intravenous tube into your veins and then wheel you to the operation theatre on a stretcher.

What to expect during surgery?

1. Video-assisted thoracoscopic surgery usually takes about 2 to 3 hours.
2. All the procedure is done under the influence of general anaesthesia. So, you will be asleep during the whole procedure and will not feel any pain.
3. The surgeon will make three small incisions in your chest, forming a triangular confirmation.
4. A thoracoscope, a flexible tube with a camera at the head, would be inserted into one incision and the instruments in other incisions. 
5. After the surgery, the surgeon closes the cuts using self-dissolving sutures. Then it is bandaged by an experienced nurse. 

What to expect after surgery? 

1. The drain tube is likely to be present at the time when you will wake up after the completion of surgery.
2. The drain tube is used to drain the fluids from your chest cavity.
3. Medical staff will continuously check your heart rate and blood pressure during your stay at the hospital.
4. Stay at the hospital will vary depending upon the technique used by the surgeon.
5. Surgeons will prescribe you some antibiotics to prevent the chances of infection.
6. A breathing therapist may also assist you by giving you breathing sessions.
7. Although the surgery includes minimal invasion, sometimes patients may feel slight discomfort around the ribs.

First follow-up appointment

1. A follow-up appointment with the surgeon may be scheduled after 7 to 10 days of the surgery.
2. Your surgeon may give you instructions regarding recovery at home.
3. The surgeon may assess the wound sites and signs of recovery at follow-ups.
4. They will provide guidelines about the care at home and when you can return home.
5. Most people who undergo VAT surgery can return to work after three to four weeks of surgery.

1. In general, you may be able to return to work (if you have a sedentary job)
2. resume driving and participate in most non-strenuous activities within 4 to 6 weeks after minimally invasive thoracic surgery.
3. You can resume heavy lifting and other more strenuous activities within 6 to 12 weeks after surgery

Immediately consult a doctor if you experience any of the following signs and symptoms. 

1. Postprocedural fever (Fever after the operation)
2. Leaking of air from the lungs that do not heal on time
3. Infection in the wound of the incision
4. Draining of pus from the wound
5. Chest pain
6. Coughing up blood
7. Redness and swelling at the site of sutures.