The field of video-assisted thoracoscopic surgery (VATS) has evolved from our experience with laparoscopic procedures now routinely performed by the general surgeons. In the past we used rudimentary devices to peer into the chest; now we utilize advanced video technology, computers and high-tech electronics to perform many operations that formerly required open large incision thoracotomy. In essence, video-assisted surgery allows the thoracic surgeon to accomplish the same goal as the comparable open procedure but with less pain, less morbidity and a shorter hospital stay for the patients.
At USC the Thoracic surgeons utilize VATS to examine the chest cavity from within and to perform diagnostic procedures such as lung, diaphragmatic and pleural biopsies. Increasingly complex procedures are now being performed such as lung resections, evacuation of pleural based problems, decortication, anti-reflux procedures, diaphragmatic plication.
Watch the Movie: Video Assisted Thoracoscopy
Time: 4 minutes 31 seconds
Traditional surgical approaches have utilized a single large incision (cut) that is placed between the patient's ribs. The ribs are then spread apart, allowing the surgeon to look directly into the patient's chest. The surgery is then performed via this single large opening. These incisions are known as thoracotomies, and while very safe, are uncomfortable. By utilizing VATS, this large incision is avoided, thereby sparing the patient some of the post-operative pain and assisting them with a potentially quicker recovery.
In this video, the surgeon uses small instruments that have been introduced into the patient's chest via small (1/2-inch) ports. The surgeon views a video screen that shows the camera image.
There are 4 parts to this video:
In Part 1, the surgeon is "exploring" the chest using VATS technology. The device that looks like a fan is used to move the lung around.
In Part 2, the patient has recurrent collection of fluid in the chest secondary to a cancer, which is referred to as a "malignant pleural effusion". In the video, you see the surgeon sucking out the fluid. The white flashing light is actually sterile talcum powder being introduced into the chest. The talcum powder causes the lung to adhere to the chest wall, hopefully not allowing fluid to collect in this space.
In Part 3, the surgeon is sampling a lymph node from the lung to get a biopsy, to see if cancer has spread to the lymph nodes.
In Part 4, the surgeon is removing an abnormal mass from the lung. The mass was being removed to see if it was a cancer. It is placed in a small plastic bag to prevent any cancer cells from coming into contact with the chest wall as it is removed through a small (1/2 inch) incision.