17617 Video Assisted Thoracic Surgery Vats

Overview

Video-assisted thoracic surgery (VATS) is chest surgery done through a few small cuts instead of one large one. The surgeon makes a small opening and passes in a thin tube with a tiny camera on the end. The camera shows the inside of your chest on a screen. Using other small cuts, the surgeon then works with long, thin tools. 'Thoracic' means chest, and 'video-assisted' means the surgeon watches a screen while they operate. Because the cuts are small, most people have less pain and get back to everyday life sooner than with open chest surgery.

Yes. VATS is now one of the most common ways to carry out many chest operations. For lots of procedures it has largely replaced open chest surgery, because recovery is usually easier.

VATS can be done at almost any age, from children to older adults. It is most often used in adults who need a lung biopsy, treatment for a collapsed lung, fluid or infection around the lungs drained, or part of a lung removed. Before offering surgery, your team will check your general health and how well your heart and lungs are working.

Symptoms

Common symptoms

• VATS is not an illness, so it has no symptoms of its own. People are usually offered VATS because of a chest problem that causes symptoms such as these:
• A cough that will not go away, or a cough that keeps changing
• Shortness of breath, especially with walking or effort
• Chest pain, particularly when breathing deeply or coughing
• Coughing up blood, even small streaks
• A lung that keeps collapsing (pneumothorax), causing sudden sharp chest pain and breathlessness
• A spot, shadow or lump seen on a chest X-ray or scan
• Fluid or infection around the lungs, which can cause heaviness, fever or a dull ache

Causes

Main causes

• A lung nodule or mass that needs a sample (biopsy) or removal
• A collapsed lung (pneumothorax) that keeps coming back or is not healing on its own
• Fluid around the lung (pleural effusion), or a thick or infected collection called an empyema
• Part of a lung being removed — such as a lobe (lobectomy) or a wedge — often for early-stage lung cancer
• Problems with the lining of the chest, the diaphragm, or the thymus gland
• Some operations on the food pipe (oesophagus) or on nerves inside the chest
• Taking a sample of tissue when other tests have not given a clear answer

Risk factors

• Smoking, which raises the risk of lung problems and slows healing
• Older age and other health conditions, such as heart or lung disease
• Being very overweight, which can make surgery and recovery harder
• Diabetes or a weakened immune system, which can slow wound healing
• Scarring in the chest from earlier surgery or infection, which can make keyhole surgery more difficult
• Bleeding problems, or medicines that thin the blood
• A chest infection or recent illness, which may mean surgery is delayed until you are better

When to see a doctor

See a doctor urgently if:

• You have sudden sharp chest pain with breathlessness
• You are coughing up blood
• You have a fever with chest pain or a feeling of heaviness in your chest
• Your breathing is getting worse over hours or days rather than staying the same
• After surgery: pain, breathlessness or wound problems that are getting worse rather than better

Book a routine appointment if:

• You have been told you may need chest surgery and want to talk it through
• You have a cough lasting more than three weeks, or a cough that has changed
• You have had a collapsed lung before and want advice on what to watch for
• You are short of breath with everyday activities and it is gradually getting worse
• A scan has shown a spot on your lung and you are waiting to hear what happens next

Diagnosis

VATS is a treatment, not a diagnosis. Your doctor works out whether you need it by asking about your symptoms, examining you, and reviewing scans and tests. If surgery is planned, you will also have a pre-assessment appointment — a set of checks to make sure you are fit for the anaesthetic and to plan the safest way to look after you.

Tests that may be done

• Chest X-ray — a quick picture of your lungs and the space around them
• CT scan — detailed three-dimensional pictures of your chest
• PET scan — sometimes used to see how active a lump is
• Lung function tests — breathing tests that show how well your lungs work
• Blood tests, including a check of your blood count and how well your blood clots
• ECG (heart tracing), and sometimes an ultrasound of the heart
• Bronchoscopy — a camera test inside your airways — or a needle biopsy taken before surgery
• A test to check your oxygen levels, such as a walking test or a blood gas test

What to expect at your appointment

Before the operation you will meet your surgeon and your anaesthetist (the doctor who puts you to sleep). They will explain what will be done, where the cuts will be, and what recovery usually looks like. You will be asked not to eat or drink for a set number of hours beforehand. You will have a general anaesthetic, so you will be asleep throughout. Afterwards you will wake up in a recovery area, often with a chest drain — a thin tube that clears air or fluid — and with pain relief to keep you comfortable. Most people go home within a few days, depending on what was done.

Treatment

VATS is itself the treatment. The operation is done under a general anaesthetic. The surgeon makes a few small cuts, usually on the side of your chest, and passes in a camera and long, slim instruments. Sometimes one cut is made slightly larger so that tissue can be removed. At the end, the cuts are closed with stitches, glue or staples. You will usually have a chest drain for a short time, and your team will help you with breathing exercises and with getting up and moving.

Self-care at home

• Follow your wound care advice: keep the cuts clean and dry until your team says otherwise
• Take pain relief as advised, so that you can breathe deeply and move around comfortably
• Do the breathing exercises and gentle shoulder and arm movements your physiotherapist teaches you
• Build up walking a little each day, but avoid heavy lifting, pushing or vigorous exercise until you are cleared
• Do not drive until your team says it is safe — often a few weeks after chest surgery
• Avoid swimming, hot tubs and soaking in baths until your wounds are fully healed
• Go to all follow-up appointments, and ask for your results if you have not heard
• Stop smoking if you can — it helps your lungs recover and lowers the risk of chest infections

Medical treatments

The care around VATS is mostly about helping you recover comfortably. Your team may prescribe pain relief, and sometimes medicines to prevent infection or blood clots — they will explain what each one is for and how to take it. Physiotherapy helps your lungs clear and keeps your chest and shoulder comfortable. If the tissue removed shows something that needs more treatment, your specialist team will talk you through the options, which may include further surgery, chemotherapy, radiotherapy, or careful monitoring with regular scans.

When is surgery considered?

VATS may be recommended if you need a lung biopsy, if a collapsed lung keeps coming back or is not healing, if fluid or infection around the lung needs draining, or if part of a lung needs removing — often for early-stage lung cancer. It is also used for some other chest operations. Whether VATS is right for you depends on what needs doing, your general health, and whether there is scarring in your chest from earlier surgery. Your surgeon will explain the benefits and risks of VATS compared with open surgery for your particular situation.

Living with this condition

Most people feel tired and sore for the first one to two weeks. Breathing deeply, coughing and moving around can be uncomfortable, but gentle activity actually helps your recovery. Many people manage light household tasks within two to three weeks, return to driving after a few weeks, and get back to work within four to eight weeks — depending on the job and on what was done. You may notice a patch of numbness or an odd sensation around the scars; this usually settles over time. Build your strength back gradually and let people help you in the meantime.

Lifestyle tips

• Pace yourself: short, frequent bursts of activity are better than one long push
• Keep your home clear of trip hazards while you are moving more slowly
• Ask for help with shopping, lifting and heavy chores for the first few weeks
• Avoid smoky places and people with coughs or colds while you heal
• Keep a simple note of your pain, temperature and how far you can walk, so you can tell your team how you are doing
• Return to hobbies gently, and check with your team before restarting anything strenuous

Diet and exercise

Eat regular, balanced meals to help your body heal, and drink enough fluid — good hydration helps loosen chest secretions. If your appetite is low at first, small snacks through the day work better than large meals. Gentle walking is the best exercise early on: start with short trips around the house and build up. Your physiotherapist will teach you breathing exercises and shoulder movements that protect your chest and keep your lungs clear. Avoid heavy weights, vigorous gym sessions and contact sports until your team confirms it is safe.

Mental health and emotional wellbeing

It is very common to feel anxious before chest surgery, and to feel low, frustrated or tearful during recovery. Waiting for results can be especially hard. These feelings usually ease as you get stronger, but you do not have to cope alone. Talking to family, friends, your GP, or a counsellor can really help. If low mood or worry is lasting more than a couple of weeks, or is affecting your sleep and appetite, please tell your doctor — support is available, and asking for it is a sign of strength, not weakness.

Prevention

You cannot always prevent the chest problems that lead to VATS, but you can lower your risk. Not smoking — or getting help to stop — is the single biggest thing you can do for your lungs. Treating chest infections early, keeping up with your vaccinations, and getting unusual or lasting symptoms checked promptly all help too. If you are due to have surgery, stopping smoking even a few weeks beforehand can improve how well you heal.

Vaccines

Keep up to date with the vaccinations your doctor recommends, such as flu and pneumonia vaccines for people with lung conditions. These lower the chance of chest infections, which can cause problems before and after surgery. Ask your GP or pharmacist what you are due for.

Screening programmes

There is no screening test for VATS itself, because it is a procedure rather than an illness. Some countries offer lung cancer screening for people at higher risk, such as long-term smokers or ex-smokers of a certain age. Ask your doctor whether this is available where you live and whether you qualify.

Complications

If left untreated

• A collapsed lung that is not treated can cause serious breathing problems and low oxygen levels
• Fluid or infection around the lung can get worse and make you very unwell
• A lung problem that is not checked may be found later, when treatment is more difficult
• Ongoing breathlessness and tiredness can affect work, sleep and everyday life
• Rarely, serious chest infections can spread and become life-threatening without treatment

Long-term outlook

Most people recover well after VATS. Because the cuts are small, many people are home within a few days and back to normal activities within a few weeks, with less pain than open chest surgery would cause. Recovery is not always a straight line — some days will feel easier than others, and it is normal to need more rest at first. Your own outlook depends on what was treated and your general health, so do ask your surgeon or specialist nurse what they expect for you.

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