VIDEO-ASSISTED THORACOSCOPY

What is video assisted thoracoscopy (VATS) :

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical procedure for  diagnose and treat problems in chest like for taking biopsy tissue for diagnose disease or cancer, remove collected plureal fluid and air due to any trauma and lung disease.

This procedure done by Thoracic surgeron in the operation theatre under the general anesthesia. 

Indication for the surgery :

-Resection of pulm, nodule 

-Bullectomy

-Lung Bx/ lobectomy

-Pneumonectomy

-Pericardial window

-Aspirations of pleural fluid

-staging of lung cancer with pleural effusion and of diffuse malignant mesothelioma.

-Diffuse lung disease by taking biopsy form inside.

-Pleural biopsy taken from parietal pleura and also taken from intercostal space and reduce the risk of hemorrhage. 

-Typically two to six biopsies of pleural lesions will established the diagnosis.

-Surgery to relieve excessive sweating (hyperhidrosis)

-Surgery to treat certain types of esophageal disorders

-Certain procedures involving the heart, ribs, spine and diaphragm

Contraindication of the surgery in which patient is not physical fit for surgery and not able to perform for surgery :

-Advance emphyema

-Inability to tolerate lateral position.

-Unstable cardiovascular or heamodynamic status.

-Presence of severe, uncorrectable hypoxemia despite oxygen therapy. 

-Bleeding diathesis (platlets count should be in >60,000 and the international normalised ratio (INR <1.2)

-Pulmonary hypertension 

-Refractive cough.

-Drug hypersensitivity. 

-Reduced general health status with short suspected survival.

Pre-procedure assessment and investigation :

These may include imaging tests, laboratory tests, pulmonary function tests and X-Ray chest, CT-chest, and cardiac evolution. 

Anticoagulants like aspirin or blood thinners should be stopped atleast 3 to 7 days before the surgery and normalised of the coagulation profile confirmed prior to the procedure and discuss cardiologist before the procedure. 

Thoracoscopy done under the full general anesthesia with double lumen flexible endotracheal tube in this only one lungs under the single ventilation. And this procedure done by two port and also three ports.

Antibiotics prophylaxis is, however, strongly recommended in patients with risk factor for infection including asplenia, prosthetic heard valves, previous endocarditis

In this procedure patient has to lateral position with side to be examined upper most and surgeon stand behind the patient. 

Skin preparation, skin over the whole hemi-thorax of the side to be examined should be prepared with an alcohol based skin sterlising solution. The skin preparation should include the axilla.

Insertion of trocar/introducer:

This procedure done by two port and also three ports.1cm skin incision on the skin, The 5mm two or three port should be gently insert and Firts port 4th intercostal posterior axillary line and second port is 3rd intercostal anterior axillary line and third  5th or 6th intercostal posterior axillary line introduce into the pleural cavity then Pleural fluid aspirated with a soft suction catheter.

After the ports introducing a telescope (thoracoscope) attached with video camera and cold light source cavity inflate with CO2 (carbon di oxide) gas. Pressure should be CO2 gas is 4mmHg and flow of the CO2 gas should be 8. CO2 Pressure also decide by surgeon during the surgery & circumstances of the procedure. Some time surgeon keep pressure 2-3 mmHg.

In case of large pleural effusion, 1.5-3 litre of pleural fluid may be removed.

Safe thoracoscopy requires a large pleural cavity between the lungs and chest wall. 

Complications of video-assisted thoracoscopic after  surgery include:

-Pneumonia, a lung infection

Bleeding

-Temporary or permanent nerve damage

-Damage to organs near the procedure site

After the procedure patient shifted to recovery for observation, antibiotics and painkiller given to patient and strictly watching vitals sign of the patient,  watch and record urine output, if ICD tube or chest tube was inserted then strictly watch ICD drain output and recorded by nursing staff. 

Image source :google 

Indore