A new method for chest surgery - Let's learn everything about VATS (Video-assisted thoracic surgery)

When you or someone you know says they need to have chest surgery, you're a little scared, right? When we hear the word "chest surgery," we think of a big incision, a few days in the hospital, and a lot of pain. That fear is actually justified. But now, medical science has advanced a lot. Today, we're going to talk about a chest surgery method that doesn't require such big incisions, but rather small incisions. This is called VATS. The benefits to patients, the recovery time, and many other things are different from traditional surgeries. Let's talk about this in detail .

Simply put, what is VATS?

The full name of VATS is Video-assisted thoracic surgery . In Sinhala, it means "video-assisted thoracic surgery." Although the name may sound complicated, what happens in this procedure is very simple.

Think about it, normally when you do chest surgery, you have to make a large incision in the chest area, through the ribs to reach organs like the lungs or heart. This is called a `(Thoracotomy)`. But in the VATS method, you don't make such a large incision. Instead, you just make a few small holes, about an inch or a half, between the ribs.

Then, a thin tube with a camera attached to it (a thoracoscope) is passed through one of these holes into the chest cavity. This camera magnifies everything inside the chest, including organs and tissues, and shows it clearly on a video monitor. Now the surgeon can watch this video and insert delicate surgical instruments through other small holes to perform the surgery with great precision. It's like a video game, but a very complex and responsible job.

This is a type of minimally invasive surgery, meaning it involves minimal incisions. This means that the patient experiences less pain, bleeding, and recovery time.

What types of diseases are treated with VATS surgery?

VATS surgery is used to diagnose and treat many diseases of the chest cavity. It is especially popular for lung cancer . It is also used for metastatic cancer that has spread to the lungs from other sites.

In addition to this main reason, VATS surgery is useful for a number of other diseases. Let's see what they are.

Types of VATS surgery

Surgeons use VATS technology to perform a variety of surgeries, including:

• VATS lung resection: This involves removing a diseased portion of the lung.
• Wedge resection: Removal of a small cone-shaped piece of lung tissue.
• Lobectomy: The complete removal of one of the lobes of the lung.
• Pneumonectomy: Complete removal of one lung.
• Esophagectomy: Removal of the food pipe due to a cause such as cancer.
• Thymectomy: Removal of the diseased thymus gland.
• `Decortication`:Removing infected membranes and scars that have formed around the lungs and allowing the lungs to expand properly again.
• Lung volume reduction surgery (LVRS): In conditions such as COPD, damaged parts of the lung are removed, allowing the healthy parts to function properly.

How should I prepare for this surgery?

Like any surgery, this one requires careful preparation. The most important thing is to follow your doctor's instructions exactly. You will usually be asked to do things like:

• Fasting: You will be advised to refrain from eating or drinking for a few hours before the surgery.
• Stopping Medications: You may be asked to stop taking some medications, especially blood thinners, vitamins, and Ayurvedic medicines, before surgery. Discuss this with your doctor.
• Quitting smoking: If you are a smoker, it is essential to quit completely, at least a few weeks before surgery. Smoking can cause complications during anesthesia and delay recovery after surgery.

You will also need to undergo several tests to check your physical fitness before the surgery.

• Blood tests: Tests such as a complete blood count (CBC).
• Heart tests: An EKG or an `Exercise stress test`.
• Imaging tests such as chest X-ray or CT scan / PET scan.
• Pulmonary function testing: See how well your lungs are working.
• Upper endoscopy or barium swallow X-ray.

What happens during surgery?

Don't worry about this. After you are taken to the operating room, you will first be given general anesthesia. This means that you will be completely asleep and will not feel anything. You will not feel any pain or discomfort until the surgery is over.

The surgical team then follows these steps:

1. You will be turned and placed on the side opposite to the side where the surgery will be performed.

2. Several small incisions (usually 2-4) are made in the chest, about an inch apart, between the ribs. Sometimes there is also a ``uniport VATS - U-VATS'' method, which is done through a single hole.

3. A camera (thoracoscope) is inserted through one of the holes and the inside of the chest is viewed on a video screen.

4. Special surgical instruments are inserted through the other holes and, while looking at the images seen on the video, the diseased tissue or organ part to be removed is very carefully removed.

5. After surgery, a chest tube is temporarily placed to drain any excess air or fluid that may be accumulating in the chest cavity.

6. Finally, the small incisions are closed with dissolvable stitches or staples.

In some advanced hospitals, this surgery is even performed using `robotic technology`. There, the doctor performs the surgery while looking at a computer screen and controlling a robotic arm. A VATS surgery for lung cancer usually takes about two to three hours.

What are the benefits and risks of this surgery?

Let's look at these two separately.

What happens after the surgery and how long does it take to recover?

After surgery, the removed tissue is sent to a laboratory for testing. This is called a `Biopsy` . A `Pathologist` examines the tissue under a microscope to see if there are any cancer cells, signs of infection, or other conditions. Your further treatment will be determined based on that report.

After surgery, you will be given medication to control the pain. Also, the nurses and physiotherapists will encourage you to do deep breathing exercises . Walking is also very important for a speedy recovery.

Before you go home, a doctor will remove the chest tube.

Recovery time varies from person to person and depending on the type of surgery performed. Some surgeries can take as little as two weeks to recover from, while others can take as long as eight weeks.

Take care of these things after you go home:

• Change dressings on cuts regularly as directed by your doctor.
• Do not drive or lift heavy objects until the doctor tells you to.
• Walk a little at least three times a day to prevent blood clots in your legs.
• Take prescribed painkillers and antibiotics exactly on time.
• Be sure to go to the clinic on the date given for the re-examination.

When should I call the doctor?

If you develop symptoms like these after returning home, you should call your doctor immediately .

• If you experience severe chest pain .
• If you feel difficulty breathing .
• If you notice signs of an infection . For example:
• Redness, swelling, or yellow discharge around the incision.
• Fever.

Don't ignore these symptoms. It's very important to seek treatment quickly.

In conclusion, VATS is a major advancement in the field of thoracic surgery. For someone battling a disease like cancer, it is a great relief to be able to recover quickly after surgery, experience less pain, and return to their normal life sooner. If you have been scheduled for this type of surgery, don't be afraid, talk to your doctor about it thoroughly, and ask all the questions you have.