Video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery
Diagram showing video assisted thoracoscopy (VATS)
MeSH	D020775
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Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via small incisions. The surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports". These small ports are advantageous because the chance for infection and wound dehiscence are drastically reduced. This allows for a faster recovery by the patient and a greater chance for the wound to heal.

Traditionally, thoracic surgery performed for diagnosis or treatment of chest conditions has required access to the chest through thoracotomy or sternotomy incisions. Sternotomy requires the use of a sternal saw to divide the sternum and requires spreading of the divided portions of the sternum with a sternal retractor to allow for visualization of the thoracic structures, passage of instruments into the chest, and removal of specimens. Thoracotomy, as most commonly performed, requires division of one or more major muscles of the chest wall including the latissimus dorsi, pectoralis or serratus muscles, along with spreading of the ribs with a rib spreader. Because the joints of the ribs with the vertebral bodies have only limited flexibility, the use of a rib spreader usually results in rib fractures in the process of rendering the interspace between the ribs wide enough to perform diagnostic or therapeutic maneuvers. Because of this, thoracic surgeons generally intentionally remove a section of one or more ribs in an effort to prevent splintered rib fractures associated with the use of a rib spreader. Sternotomy and thoracotomy have been proven over decades to provide highly effective means of access to thoracic structures and in general are tolerated by patients. However, both incisions have the potential for causing significant pain that may last for extended periods and both result in bony fractures that require a minimum of six weeks to heal during which time patients must refrain from heavy lifting or strenuous activity. The great advantage of VATS over sternotomy or thoracotomy is avoidance of muscle division and bone fractures that allows for diminished duration and intensity of pain and a shorter time to return to full activity.