Video-Assisted Thoracic Surgery

Since the early 1990s, video-assisted thoracoscopic surgery (VATS) has revolutionized surgical care. The era of VATS is sufficiently mature that enough data have accrued to compare the efficacy of VATS with that of open procedures. In this regard, anatomic pulmonary resection by VATS has led to significant reductions in morbidity, mortality, and hospital length of stay, allowing patients a more expeditious return to regular activities. VATS has been used in the treatment of both benign and malignant diseases of the chest. Furthermore, VATS may be used in selected patients with early-stage lung cancer without breaching oncologic surgical principles. This review covers the case for VATS technology; operative planning; basic thoracoscopy operative technique; VATS procedures for pleural disease, pulmonary wedge resection, spontaneous pneumothorax and bullous disease, lung volume reduction surgery, lobectomy, mediastinal lymph node dissection, pericardial window, mediastinal masses, management of thoracic trauma, sympathectomy and splanchnicectomy; and cost considerations. Figures show preoperative evaluation; proper patient position in the operating room, with the patient propped on pontoons; triangulation technique for port placement in relation to intrathoracic structures and targets; thoracoscope and trocar placement; video and monitors; wedge resection with lung compression clamp; tissue-reinforced stapler  inserted into the chest; endoleader looped around the superior pulmonary vein; endoleader looped around the truncus anterior and its branch; and division of the upper lobe bronchus. Tables list indications and relative contraindications for VATS procedures, basic instruments and equipment used for VATS procedures, and operative steps for VATS lobectomy.   This review contains 10 highly rendered figures, 3 tables, and 35 references Key words: Video-assisted thoracoscopic surgery; VATS; Minimally invasive thoracic surgery; Thoracoscopy; Rigid thoracoscope; Flexible thoracoscope; Thoracoport