About Video-Assisted Thoracic Surgery ::
VATS (Video-Assisted Thoracic Surgery) is surgery performed with the use of an endoscope (a small video camera) to visualize structures inside the chest. The use of an endoscope to see allows the surgeon to make small incisions to perform operations that have traditionally been performed through large thoracotomy incisions. The first report of Thoracoscopy (the precursor of VATS) was published in 1911 by Dr. H. C. Jacobaeus of Stockholm.
He used a modified cystoscope to look into the pleural cavity, describing lysis of adhesions endoscopically. For many years VATS and Thoracoscopy were chiefly used to perform relatively simple procedures such as pleural biopsy, lung biopsy, drainage of effusion, and treatment of pneumothorax. However, pioneers in VATS surgery introduced more complex procedures such as VATS Lobectomy.
VATS Lobectomy should fit the following criteria ::
VATS Lobectomy is considered an advanced VATS procedure. VATS Lobectomy is the removal of a lobe (or segment or entire lung) through small incisions using endoscopy as the primary means of visualization inside the chest. VATS Lobectomy should fit the following criteria:
- Anterior approach
- Incision less than or equal to 7 cm in length.
- No rib spreader placed in the incision.
- 30 degree angled or flexible tip endoscope for visualization.
- Use of endoscopic cutting/stapling device for division of tissues.
- Anatomic dissection and resection of structures.
- Complete mediastinal lymph node staging.
Notes :: Two landmark papers were published in 2006: 1,100 cases of VATS lobectomy by Drs. McKenna, Fuller and Houck at Cedars-Sinai in Los Angeles, CA., and 500 VATS lobectomy cases by Dr. Thomas D’Amico at Duke University in Raleigh-Durham NC. Those papers demonstrated that VATS Lobectomy was safe and effective for the treatment of lung cancer, decreased the mortality compared to open thoracotomy resection, and decreased the length of stay. Other publications have demonstrated earlier recovery from surgery, reduction in pneumonia, improvement in post-operative pain, and the ability to begin chemotherapy sooner than with open thoracotomy. This experience published in the academic setting has now been transferred to an increasing number of private practices.
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