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Overview of video-assisted thoracoscopic surgery (VATS)

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


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 [1].


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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Literature review current through: Dec 2016. | This topic last updated: Mon Aug 24 00:00:00 GMT+00:00 2015.
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  1. Gonzalez-Rivas D, Fieira E, Delgado M, et al. Evolving from conventional video-assisted thoracoscopic lobectomy to uniportal: the story behind the evolution. J Thorac Dis 2014; 6:S599.
  2. Neragi-Miandoab S, Linden PA, Ducko CT, et al. VATS pericardiotomy for patients with known malignancy and pericardial effusion: survival and prognosis of positive cytology and metastatic involvement of the pericardium: a case control study. Int J Surg 2008; 6:110.
  3. Ng CS, Yim AP. Technical advances in mediastinal surgery: videothoracoscopic approach to posterior mediastinal tumors. Thorac Surg Clin 2010; 20:297.
  4. Pompeo E, Mancini F, Ippolito E, Mineo TC. Videothoracoscopic approach to the spine in idiopathic scoliosis. Thorac Surg Clin 2010; 20:311.
  5. Song IH, Yum S, Choi W, et al. Clinical application of single incision thoracoscopic surgery: early experience of 264 cases. J Cardiothorac Surg 2014; 9:44.
  6. Battoo A, Jahan A, Yang Z, et al. Thoracoscopic pneumonectomy: an 11-year experience. Chest 2014; 146:1300.
  7. Carballo M, Maish MS, Jaroszewski DE, Holmes CE. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009; 4:13.
  8. Hennon MW, Dexter EU, Huang M, et al. Does Thoracoscopic Surgery Decrease the Morbidity of Combined Lung and Chest Wall Resection? Ann Thorac Surg 2015; 99:1929.
  9. Kimura T, Inoue M, Kadota Y, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg 2013; 44:e214.
  10. Leshnower BG, Miller DL, Fernandez FG, et al. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 2010; 89:1571.
  11. Li Y, Wang J. Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients. ANZ J Surg 2013; 83:664.
  12. Limmer KK, Kernstine KH. Minimally invasive and robotic-assisted thymus resection. Thorac Surg Clin 2011; 21:69.
  13. Linden D, Linden K, Oparka J. In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection? Interact Cardiovasc Thorac Surg 2014; 19:107.
  14. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 2012; 256:95.
  15. Luketich JD, Pennathur A, Franchetti Y, et al. Minimally invasive esophagectomy: results of a prospective phase II multicenter trial-the eastern cooperative oncology group (E2202) study. Ann Surg 2015; 261:702.
  16. Ahmed N, Chung R. Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg 2010; 76:1236.
  17. Billeter AT, Druen D, Franklin GA, et al. Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review. Langenbecks Arch Surg 2013; 398:515.
  18. Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc 2009; 24:44.
  19. Chung JH, Lee SH, Kim KT, et al. Optimal timing of thoracoscopic drainage and decortication for empyema. Ann Thorac Surg 2014; 97:224.
  20. Zahid I, Nagendran M, Routledge T, Scarci M. Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. Curr Opin Pulm Med 2011; 17:255.
  21. Shaikhrezai K, Thompson AI, Parkin C, et al. Video-assisted thoracoscopic surgery management of spontaneous pneumothorax--long-term results. Eur J Cardiothorac Surg 2011; 40:120.
  22. Hofferberth SC, Cecchin F, Loberman D, Fynn-Thompson F. Left thoracoscopic sympathectomy for cardiac denervation in patients with life-threatening ventricular arrhythmias. J Thorac Cardiovasc Surg 2014; 147:404.
  23. Oncel M, Sadi Sunam G, Erdem E, et al. Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases. Cardiovasc J Afr 2013; 24:137.
  24. Agrawal D, Meekison L, Walker WS. Long-term clinical results of thoracoscopic Heller's myotomy in the treatment of achalasia. Eur J Cardiothorac Surg 2008; 34:423.
  25. Hu X, Lee H. Complete thoracoscopic enucleation of giant leiomyoma of the esophagus: a case report and review of the literature. J Cardiothorac Surg 2014; 9:34.
  26. Jiang G, Zhao H, Yang F, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus 2009; 22:279.
  27. Kilic A, Schuchert MJ, Awais O, et al. Surgical management of epiphrenic diverticula in the minimally invasive era. JSLS 2009; 13:160.
  28. Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty. World J Surg 2013; 37:1661.
  29. Rothenberg SS. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience. Dis Esophagus 2013; 26:359.
  30. van der Zee DC, Straver M. Thoracoscopic aortopexy for tracheomalacia. World J Surg 2015; 39:158.
  31. Yu D, Han Y, Zhou S, et al. Video-assisted thoracic bronchial sleeve lobectomy with bronchoplasty for treatment of lung cancer confined to a single lung lobe: a case series of Chinese patients. J Cardiothorac Surg 2014; 9:67.
  32. Zhao G, Dong C, Yang M, et al. Totally thoracoscopic tracheoplasty for a squamous cell carcinoma of the mediastinal trachea. Ann Thorac Surg 2014; 98:1109.
  33. Lonner BS, Auerbach JD, Levin R, et al. Thoracoscopic anterior instrumented fusion for adolescent idiopathic scoliosis with emphasis on the sagittal plane. Spine J 2009; 9:523.
  34. Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg 2012; 256:487.
  35. Khan NU, Yonan N. Does preoperative computed tomography reduce the risks associated with re-do cardiac surgery? Interact Cardiovasc Thorac Surg 2009; 9:119.
  36. Santini M, Fiorello A, Vicidomini G, Laperuta P. The use of LigaSure for preservation of a previous coronary artery bypass graft by using the left internal thoracic artery in a left upper lobectomy. J Thorac Cardiovasc Surg 2008; 136:222.
  37. Halkos ME, Sherman AJ, Miller JI Jr. Preservation of the lima pedicle after cardiac surgery in left upper lobectomy. Ann Thorac Surg 2003; 76:280.
  38. Bagan P, De Dominicis F, Hernigou J, et al. Complete thoracoscopic lobectomy for cancer: comparative study of three-dimensional high-definition with two-dimensional high-definition video systems †. Interact Cardiovasc Thorac Surg 2015; 20:820.
  39. Ibrahim M, Menna C, Maurizi G, et al. Impact of Transcollation technology in thoracic surgery: a retrospective study. Eur J Cardiothorac Surg 2016; 49:623.
  40. Seder CW, Hanna K, Lucia V, et al. The safe transition from open to thoracoscopic lobectomy: a 5-year experience. Ann Thorac Surg 2009; 88:216.
  41. Toker A, Tanju S, Ziyade S, et al. Learning curve in videothoracoscopic thymectomy: how many operations and in which situations? Eur J Cardiothorac Surg 2008; 34:155.
  42. Toker A, Tanju S, Sungur Z, et al. Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: results of 90 patients. Surg Endosc 2008; 22:912.