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Thoracic & Lung Transplant Surgeon | Medanta – The Medicity, Gurugram

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Dr Mohan Venkatesh Pulle

MBBS | DNB (General Surgery, Gold Medalist) | DNB (Thoracic Surgery, Gold Medalist)
Thoracic & Lung Transplant Surgeon | Medanta – The Medicity, Gurugram

INSTITUTE OF CHEST SURGERY LOGO

Video-Assisted Thoracoscopic Surgery (VATS) in Lung Treatments: A Minimally Invasive Approach

Treatment

Video-Assisted Thoracoscopic Surgery (VATS) in Lung Treatments: A Minimally Invasive Approach

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Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used in various lung treatments. It involves the use of a video camera and specialized instruments to perform surgery through small incisions in the chest. VATS has gained popularity over the years as it offers several benefits over traditional open surgeries, including reduced trauma, shorter hospital stays, and faster recovery. This article explores the process and advantages of VATS surgery in lung treatments

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1. The VATS Procedure

The VATS procedure involves several key steps:

  • Patient Preparation: Prior to surgery, the patient undergoes a comprehensive evaluation, including medical history, physical examination, and imaging studies (e.g., chest X-rays, CT scans). The patient’s eligibility for VATS surgery is determined based on the type and extent of the lung condition.
  • Anesthesia: On the day of surgery, the patient is placed under general anesthesia to ensure comfort and to maintain a pain-free state throughout the procedure.
  • Port Placement: Small incisions, known as ports or trocars, are made in the chest to accommodate the VATS instruments. Typically, three to four small incisions, each measuring around 1 to 2 centimeters, are made.
  • Thoracoscope Insertion: A thoracoscope, which is a thin, flexible tube with a video camera at its tip, is inserted through one of the ports. The thoracoscope provides a clear and magnified view of the inside of the chest on a video monitor.
  • Instrument Insertion: Specialized surgical instruments are inserted through the other ports. These instruments allow the surgeon to manipulate and dissect tissues, remove diseased lung tissue, or perform other necessary procedures.
  • Surgical Visualization: The surgeon views the surgical field on the video monitor, which provides an excellent view of the lung and surrounding structures, including blood vessels, airways, and lymph nodes.
  • Surgical Procedure: The surgeon performs the necessary surgical steps using the VATS instruments. The diseased tissue may be removed, lung lobes resected, or biopsies taken, depending on the specific lung condition being treated.
  • Surgical Completion: Once the surgical procedure is complete, the instruments are removed, and the small incisions are closed with sutures or surgical glue

2. VATS Lung Procedures

VATS surgery is used in various lung procedures, including:
  • Lobectomy: A lobectomy involves the removal of an entire lobe of the lung. It is commonly performed for lung cancer or non-cancerous conditions that affect a specific lobe of the lung.
  • Segmentectomy: In segmentectomy, a smaller portion of a lung segment is removed. This procedure is often employed for early-stage lung cancer or when preserving lung function is crucial.
  • Wedge Resection: Wedge resection involves removing a small wedge-shaped piece of lung tissue. This procedure is used to diagnose or treat small lung nodules or localized lung lesions.
  • Biopsy: VATS can be used to obtain lung tissue samples for diagnostic purposes. Biopsies may be performed to diagnose lung cancer, infections, or other lung conditions.
  • Pleurodesis: Pleurodesis is a procedure used to prevent recurrent pleural effusions (fluid around the lungs). VATS can be used to perform pleurodesis by creating adhesions between the lung and the chest wall, preventing the accumulation of fluid

3. Benefits of VATS Surgery

VATS surgery offers several advantages over traditional open surgeries and conventional thoracoscopic procedures:
  • Minimally Invasive: VATS is minimally invasive, resulting in smaller incisions, less tissue trauma, reduced blood loss, and shorter hospital stays compared to open surgery. Smaller incisions also lead to improved cosmetic outcomes and reduced postoperative pain.
  • Faster Recoveyr: Patients who undergo VATS lung surgery typically experience a faster recovery compared to open surgery. They may return to normal activities and work sooner, leading to improved quality of life.
  • Reduced Hospital Stay: VATS surgery often requires a shorter hospital stay, allowing patients to recover in the comfort of their homes.
  • Reduced Pain: Smaller incisions and reduced tissue trauma result in less postoperative pain compared to open surgeries.
  • Lower Risk of Complications: Studies have shown that VATS is associated with a lower risk of certain complications, such as wound infections and respiratory complications, compared to open surgery.
  • Improved Cosmesis: Smaller incisions result in less visible scars, leading to improved cosmetic outcomes and higher patient satisfaction.
  • Preservation of Lung Function: VATS procedures, such as segmentectomy and wedge resection, can preserve lung function by removing only the diseased portion of the lung while sparing healthy tissue.
  • Enhanced Visualization: The thoracoscope provides a clear and magnified view of the surgical field, offering improved visualization of structures, including blood vessels, airways, and lymph nodes.
  • Shorter Anesthesia Time: VATS surgery may require shorter anesthesia time compared to open surgery, which can be beneficial for certain patients, especially those with underlying medical conditions.
  • Reduced Risk of Infection: Smaller incisions and reduced tissue trauma decrease the risk of infection compared to larger incisions in open surgery

4. Patient Selection

While VATS surgery offers many benefits, not all patients are suitable candidates. Patient selection is based on various factors, including the type and extent of the lung condition, the surgeon’s expertise, and the location of the lung lesion.
  • Tumor Size and Location: VATS may be suitable for smaller tumors located on the periphery of the lung. Larger or centrally located tumors may require open surgery.
  • Overall Health: Patients’ overall health and lung function are important considerations for VATS surgery. Those with significant lung disease or comorbidities may not be suitable candidates.
  • Previous Surgeries: Prior surgeries or scarring in the chest cavity may impact the feasibility of VATS surgery.
  • Experienced Surgeon: VATS surgery requires specialized training and expertise. Surgeons with experience in VATS procedures may achieve better outcomes.

5. Limitations and Considerations

While VATS surgery offers significant advantages, there are certain limitations and considerations to be aware of:
  • Complexity of Procedures: Not all lung procedures can be performed using VATS. Complex cases or those requiring extensive tissue resection may be better suited for open surgery.
  • Bleeding and Conversion to Open Surgery: In some cases, bleeding or unexpected challenges during VATS surgery may require conversion to open surgery for safety reasons.
  • Longer Operating Time: VATS procedures may take longer to perform compared to open surgery. However, as surgeons gain experience with VATS, operating times may improve.
  • Limited Instrument Movement: The thoracoscope and VATS instruments have limited movement compared to a surgeon’s hands. This may make certain tasks more challenging.
  • Learning Curve: VATS surgery requires specialized training for the surgical team to ensure safe and effective utilization of the technique. Surgeons need to undergo specific training and gain experience with VATS procedures

6. Future Directions

As technology continues to advance, VATS surgery is expected to become even more sophisticated, with improvements in imaging, instrument design, and software capabilities. The integration of robotic-assisted technology into VATS procedures may further enhance surgical precision and visualization.

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Dr Mohan Venkatesh Pulle

MBBS | DNB (General Surgery, Gold Medalist) DNB (Thoracic Surgery, Gold Medalist)
Thoracic & Lung Transplant Surgeon
Medanta – The Medicity, Gurugram

An esteemed thoracic surgeon, excels in minimally invasive procedures (VATS & Robotic surgery) for both benign and malignant lung conditions. With a stellar academic background and international training, he is dedicated to offering compassionate and expert patient care.

Contact Details

  • Room no.8, 4th floor, OPD block, Institute of Chest Surgery, Chest Onco-surgery & Lung Transplantation. | Medanta - The Medicity, CH Bhaktawar Singh Rd, Sector - 38, Gurugram, 122001.
  • [email protected]
  • +919999461292
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