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Video-assisted thoracic surgery (VATS)
Video-assisted thoracic surgery (VATS) is a minimally invasive technique used for thoracic conditions, providing benefits such as reduced postoperative morbidity and quicker recovery times. The procedure employs specific ports for instrumentation and is indicated for both diagnostic and therapeutic purposes, while contraindications and potential complications must be carefully considered. Overall survival rates post-surgery are high, with 100% after one year and gradually decreasing over subsequent years.
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Video-assisted thoracic surgery (VATS)
- 1. VIDEO-ASSISTED THORACIC SURGERY (VATS) Prepared by: Racheen S. Haji University of zakho Faculty of medical sciences School of medicine Surgical department
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- 4. DEFINITION (VATS): is minimallyinvasive thoracic surgery that does not use a formal thoracotomy incision, it is principally employed in the management of (pulmonary, mediastinal, and pleural pathology. Its benefits: • Can be performed in a short time period. • Less postoperative morbidity. • Earlier return to normal activity.
- 5. The standard VATSpleurodesis procedure requires three ports placed • at the 7th intercostal space mid-axillary line. • 4th intercostal space anterior axillary line • the last port just anterior to the tip of the scapula. (Triangulated fashion)
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- 9. EQUIPMENT • Double sidedendotracheal tube • Thoracoscope, with lens and video camera • A light source and cable • Long-blade diathermy pen • Endoscopic biopsy forceps • Endoscopic staple-transection devices • Rigid or flexible trocar cannula • Thoracotomy tray • Chest tube drainage device with water seal • Suction source and tubing
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- 19. indications Diagnostic: Mediastinallymph node biopsy Pleuroscopy/pleural biopsy Tissue/lymph node biopsy (for lung cancer) Chest wall biopsy Cancer staging Therapeutic: • Pulmonary resection (for lung cancer) • Pulmonary bleb/bullae resection • Pulmonary drainage (pneumothorax, hemothorax, empyema) • Pericardial effusion drainage • Excision/biopsy of mediastinal mass and nodules • Excision of esophageal diverticulum/esophagectomy • Chest wall tumor resection
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- 21. CONTRA-INDICATIONS Absolute: • Markedlyunstable or shocked patient • Extensive adhesions obliterating the pleural space • Prior talc pleurodesis Relative: • Inability to tolerate single-lung ventilation • Previous thoracotomies • Extensive pleural diseases • Coagulopathy • Prior radiation treatment for thoracic malignancy; plan to resect • Severe COPD • Severe hypoxia • Chest wall deformity
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- 23. COMPLICATIONS Postoperative air leak Post-operativepain Hypoxemia Atelectasis Bleeding Wound infection Intercostal nerve damage Tumor implantation following VATS
- 24. Indications for conversionfrom VATS to thoracotomy Extensive pleural adhesions Uncontrolled or significant intraoperative bleeding Inability to identify a target lesion for biopsy Technical difficulties with or primary failure of video equipment and/or endoscopic instruments
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- 26. OUTCOME overall survival ratesof: 100% after 1 year 85.9% after 2 years 65.3% after 3 years 55.9% after 4 years
- 27. THANKS FOR YOURATTENTIONS. Any question…