Overview of video-assisted thoracoscopic surgery (VATS)
- Todd Demmy, MD
Todd Demmy, MD
- Professor of Oncology
- Roswell Park Cancer Institute
- Professor of Surgery
- State University of New York at Buffalo
- Elisabeth Dexter, MD
Elisabeth Dexter, MD
- Associate Professor of Oncology
- Roswell Park Cancer Institute
- Assistant Professor of Surgery
- State University of New York at Buffalo
Video-assisted thoracoscopic surgery (VATS) is a set of minimally invasive thoracic surgical procedures utilized to diagnose and/or treat intrathoracic diseases and reconstruct chest wall deformities. This topic will review: the role of VATS as a diagnostic and therapeutic tool, the preoperative assessment, instrumentation, and intraoperative challenges.
Conditions that can be treated using a VATS approach are discussed in specific topic reviews. (See "Surgical evaluation of mediastinal lymphadenopathy" and "Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation and techniques" and "Surgical management of resectable esophageal and esophagogastric junction cancers".)
VATS and thoracoscopy are frequently used interchangeable terms that describe a minimally invasive surgical (MIS) approach to the thorax. However, there are notable differences in the approaches:
VATS uses an access or utility incision that ranges from 4 to 8 cm in length and allows manipulation of multiple traditional thoracotomy or thoracoscopic instruments through a single incision at the same time, though with the possibility of using additional 0.3 to 1.5 cm incisions. The term “uniportal” refers to the use of VATS through only one utility incision and is becoming more popular .
ROLE OF VATS
VATS is used as a diagnostic and therapeutic tool as well as a reconstructive intervention for benign and malignant intrathoracic diseases. Many procedures historically performed as an open thoracotomy are now performed as VATS. Examples of diagnostic, therapeutic, and reconstructive procedures that can be performed by a VATS approach include:
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- ROLE OF VATS
- PREOPERATIVE ASSESSMENT
- PATIENT POSITIONING
- Grasping instruments
- Cutting and coagulation
- Suturing and stapling
- Suction and irrigation
- Tissue removal
- Choice of device
- INTRAOPERATIVE TECHNICAL CHALLENGES
- Patient selection
- Local tissue environment
- Learning curve
- SUMMARY AND RECOMMENDATIONS