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Overview of minimally invasive thoracic surgery

Authors
Todd Demmy, MD
Elisabeth Dexter, MD
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Video-assisted thoracoscopic surgery (VATS) is a set of minimally invasive thoracic surgical (MITS) procedures used to diagnose or treat conditions of the chest (pulmonary, mediastinal, chest wall). Most major procedures traditionally performed with open thoracotomy can be performed using smaller incisions with video assistance. A related technology, robotic-assisted thoracic surgery (RATS), uses computers to aid surgeon instrument control. The essential difference between VATS and RATS is that with VATS, the surgeon holds the instruments, whereas with RATS, the surgeon controls the instruments from the console but does not directly handle the instruments. In this topic review, we will use the broader term MITS to include VATS and RATS, using individual terms when specifically needed.

MITS provides safe, effective, and successful surgery when patients are selected appropriately. The indications have expanded as technology has improved. Continued outcome assessments are needed to ensure that MITS provides equivalent or improved outcomes compared with traditional open surgical methods. Quality of life assessments, morbidity rates, and recovery timelines also are important factors for comparison. Although few trials exist, many observational studies indicate that MITS has less perioperative morbidity and equivalent oncologic results compared with open operations. For special populations, such as frail and older adult patients, outcomes may be better. Generally, perioperative costs for minimally invasive procedures (both VATS and RATS) are higher because of the equipment used. However, overall costs may be lower due to faster patient recovery.

The diagnostic and therapeutic uses of MITS, including an overview of the indications, the preoperative evaluation, procedures, perioperative care, and surgical outcomes, are reviewed here.

THORACOSCOPIC SURGERY

In the same manner in which laparoscopic techniques reduce the need for large abdominal incisions, minimally invasive thoracic surgery (MITS) eliminates the need for thoracotomy that requires spreading of the ribs (figure 1) or sternotomy incisions (figure 2). (See "Abdominal access techniques used in laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery".)

MITS uses a thoracoscope attached to a video camera to see into the chest. The lens and the instruments necessary to perform the surgery are inserted between the ribs and into the chest cavity through one or multiple small incisions. The basic principles used in open thoracic surgery (exposure, traction, countertraction) govern MITS as well, but the surgeon's hands remain outside of the chest cavity (or, in the case of robotic surgery, at a separate console), to manipulate and work the end of the instruments, which are located inside the chest.

                                      

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Literature review current through: Jan 2017. | This topic last updated: Thu Jan 26 00:00:00 GMT+00:00 2017.
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