Video-assisted thoracoscopic surgery (VATS)

Minimal access surgery as a concept has witnessed an exponentially rapid progress and wide
acceptance in almost all the surgical sub-specialties.The traditional adage “big surgeons make big incisions” was of course a hyperbolic expression meant to convey that the surgeon should never be struggling while operating as a result of a needlesslysmall incision. This scenario has changed as the recently available video technology and advanced instrumentation has extended the reach and possibilities of a small keyhole incision. The main attractions of keyhole surgery are shorter incision, cosmetically better scar, less postoperative pain and early discharge from the hospital.

One such example is Video-assisted thoracoscopic surgery (VATS) which has been asked many times in DNB Orthopaedics Theory examination. Here is a brief glimpse :

Indications for video-assisted thoracoscopic surgery :

General intrathoracic cavity

  • Diagnosis or biopsy of any intrathoracic structure
  • Laser application for treatment of tumors
  • Diagnosis and drainage of pleural effusions
  • Treat chylothorax
  • Debride empyema Retrieval of intrathoracic foreign body


  • Wedge resection, segmentectomy, lobectomy
  • Closure of persistent/recurrent pneumothorax
  • Identification of broncho-pleural fistula


  • Lysis of adhesions
  • Pleurodesis
  • Decortication


  • Removal of mediastinal cysts
  • Thymectomy
  • Resection of posterior mediastinal neurogenic tumors

Esophagus and diaphragm

  • Tumor staging or resection
  • Resect esophagus
  • Repair diaphragm
  • Anti-reflux operations

Heart and great vessels

  • Pericardectomy
  • Diagnosis of cardiac herniation after pneumonectomy
  • Minimally invasive valve and coronary artery procedures
  • Ligation of patent ductus (infants)

Spine and nerves

  • Dorsal thoracic sympathectomy
  • Splanchnicolysis
  • Drainage of spinal abscess
  • Discectomy
  • Fusion and correction of spinal deformity


  • Assess injury
  • Treat hemorrhage
  • Evacuation of clot

Complications :

  • Hemorrhage
  • Subcutaneous emphysema
  • Empyema
  • Recurrent pneumothorax,
  • Pulmonary edema
  • Pneumonia
  • Dissemination of tumor at the thoracostomy tube site is also possible
  • Persistent postoperative air leaks

Conclusion :
Within a relatively short period of time, VATS has replaced many diagnostic and therapeutic procedures previously performed by traditional thoracotomy. By minimizing chest wall and muscle trauma, VATS not only causes less postoperative pain and fewer complications but also shortens hospital stay.


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