Video-Assisted Thoracoscopic Surgery (VATS)

Also known as thoracoscopy, this is a minimally invasive endoscopic chest operation using a small video camera known as a thoracoscope, small surgical instruments, and a small incision (Uniportal) or several incisions in order to minimise trauma to the chest tissues. Some of the benefits of video assisted thoracic surgery include minimal pain/discomfort, shorter stay in the hospital, minimal downtime with faster recovery. Most Chest Surgery operations can be performed using minimally invasive techniques, some with Uniportal VAT surgery.

Thoracotomy or Sternotomy
Also known as open chest surgery, it is more likely to be performed for larger tumours or more extensive problems through different techniques including:
THORACOTOMY: A longer cut in the side of the chest between the ribs, most likely for larger lung cancer operations like pneumonectomy or complex lobectomy. Also for repair of large diaphragmatic hernias and large tumours of the posterior mediastinum.
STERNOTOMY: Where the breastbone (Sternum) is divided in two, for heart surgery or for larger tumours of the thymus or retrosternal thyroid goitre that cannot be removed from the neck.

Robotically-Assisted Thoracic Surgery (RATS)
Robotically assisted thoracic surgery can be used for many different types of surgery, based on the principles of thoracoscopic surgery using one of many designs of surgical robot. The robot only follows the exact physical movements of the surgeon, it cannot perform any activity by itself. Published results of surgery using RATS are good and comparable to VATS, but the costs are higher and there are as yet no randomised trial data to suggest RATS is superior in outcomes to VATS.

Common Thoracic Surgical Operations
Different operations may be performed by several of the techniques listed above.

PNEUMONECTOMY: This procedure removes the entire lung and lymph nodes in order to treat lung cancer that occupies more than one part (lobe) of the lung. It is a large operation and usually performed through a thoracotomy.

LOBECTOMY: Each lung is divided into parts that are partially separate called lobes, usually three on the right and two on the left. The traditional best operation for lung cancer that is limited to one lobe is the lobectomy, although the latest evidence suggests for some tumours smaller than 2 cm a lesser operation such as segmentectomy or wedge resection may be better. It may also be performed where there is chronic infection due to bronchiectasis or hydatid cysts that is confined to one part of the lung. Surgery can often be performed via VATS techniques but for large or complex tumours, a thoracotomy may be required.

SEGMENTECTOMY: Each lobe of the lung is divided into between two and five anatomical segments. With modern surgical techniques, one or a few segments may be removed from a lobe preserving the remaining segments. This is appropriate for benign tumours and some smaller lung cancers. Again it may be performed via VATS techniques or open thoracotomy.

WEDGE RESECTION: A wedge shaped piece of lung is removed with staples to seal the cut lung edges, either to diagnose or treat lung nodules or widespread lung changes. This removes less lung than the operations above and is usually performed VATS.

BULLECTOMY AND PLEURECTOMY / PLEURODESIS: Some people have air pockets within the lungs known as bullae or blebs, usually at the top, that can leak and give rise to a pneumothorax or collapsed lung. This can be treated by removing the weak bullae and causing the lung to stick with a scar to the chest wall so that it does not collapse, either by removing the chest cavity’s inner lining or by adding a sterile talc powder to do the scarring. It is usually performed by VATS.

THYMECTOMY: In adults, the thymus is a small remnant of fatty tissue where the immune system developed during childhood. If there is a tumour within it or a person develops a condition called myasthenia gravis that is difficult to control, removal of the thymus is recommended. Again, this can be treated by VATS for smaller tumours but very large ones may require an open operation with sternotomy or a thoracotomy.

DECORTICATION: sometimes after pneumonia (chest infection) the space around the lung within the chest fills with pus, called an empyema. This can require surgery called decortication to remove the infection and scar tissue that prevents the lung from re-expanding. Surgery can often be performed via VATS techniques but for more complex empyema, a thoracotomy may be required.

THORACENTESIS or CHEST TUBE or CHEST DRAIN: The procedure is used to drain air or pleural effusions (excess fluid) that builds up between the outside layer of the lungs and the inside chest cavity. The drained fluid is analysed to identify the underlying cause of the pleural effusions.