Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure that doctors use to diagnose and treat chest conditions.

During a VATS procedure, a surgeon inserts a thin tube with a camera through a small incision between your ribs. Your surgeon may also insert special tools through another incision to perform tasks like removing a lobe of a lung or draining fluid.

The first VATS procedure was performed in 1992 to remove a lung. Before VATS, the standard technique for treating chest conditions was a more invasive procedure called a thoracotomy.

VATS has several benefits compared with a thoracotomy, including:

  • a faster recovery
  • shorter hospital stays
  • fewer complications

Read on to learn more about a VATS procedure and what it involves.

VATS can help doctors diagnose and treat many chest conditions. Surgeons may perform it to:

  • diagnose lung and other chest cancers
  • examine how far cancer has spread
  • surgically treat conditions like lung cancer, other cancers, or esophageal problems
  • remove fluid buildup in the lungs
  • treat congenital problems and conditions affecting the heart, spine, ribs, or diaphragm
  • manage infections that are untreatable using noninvasive measures

VATS is less invasive than other types of chest surgeries, but potential candidates still need to have good overall health to undergo surgery.

People with early-stage lung cancer are often candidates for this procedure. VATS with a lung lobe removal is the gold standard surgical approach for treating early-stage non-small cell lung cancer.

People who may not be good candidates for this procedure include those who have difficulty tolerating lung ventilation in isolation and those with:

When doctors use VATS as a diagnostic procedure, they may use it to determine a cancer stage to or biopsy a lung, lymph nodes, or other parts of the chest cavity.

Therapeutic uses of VATS include using it for:

Before your surgery, your doctor will talk with you about what will happen and what you need to do to prepare. Usually, you need to avoid eating for at least 6 hours before general anesthetic, and need to avoid drinking fluids for at least 2 hours before the procedure.

A healthcare professional usually administers general anesthetic before the procedure starts. You typically shouldn’t experience any pain during a VATS procedure once you fall asleep.

What to expect with VATS

  1. Once you fall asleep, a healthcare professional will fit a breathing tube into your airways to allow your lungs to inflate during surgery.
  2. You will be positioned you on your side, and your surgeon will make one or several small cuts in your chest between your ribs.
  3. Your surgeon will then insert a thin, flexible tube called a thoracoscope into one of the incisions. A camera on the end of the thoracoscope will allow them to see inside your chest cavity.
  4. Depending on the purpose of the procedure, your surgeon may also insert special tools through the incisions to remove certain tissue.
  5. Once your surgery ends, a chest tube will be inserted through one of the incisions to drain fluid and remove air. This tube usually stays in place for a couple of days until you leave the hospital.
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Many people can leave the hospital after a few days. When you go home, you’ll need to prioritize rest. Many people regain their strength over the next couple of weeks. You may have some soreness in your chest after the procedure.

In a 2020 study, researchers found that 12.7% of 1,164 people who underwent VATS had moderate to severe pain within 24 hours and 15.6% within 48 hours.

Research suggests that VATS causes less pain than traditional chest surgery, since it’s less invasive and causes less tissue damage.

In a 2022 study, researchers found that the 3-year overall survival of 230 people with non-small cell lung cancer was 78% when they received a uniport-VATS procedure with a lobectomy and 74% after traditional surgery.

Other benefits of VATS over traditional surgery include easier bleeding management and decreased:

  • surgery time
  • pain and opioid usage
  • chest tube duration
  • hospital stay lengths
  • inflammation
  • occurrences of scarring

Many experts consider VATS to be safe and effective with a low risk of complications.

All surgical procedures come with some risks. General surgical risks include:

  • bleeding
  • infection
  • blood clots
  • lung complications
  • allergy to the anesthetic

Specific VATS complications may include:

When doctors use VATS to treat a collapsed lung, the complication rate is about 4.5%.

The risk of complications is generally lower with VATS than with traditional surgery, since it’s less invasive.

VATS is a minimally invasive procedure doctors use to diagnose and treat various chest conditions. The procedure involves inserting a long tube with a camera and special instruments through a small incision or incisions between your ribs.

Experts generally consider VATS safe with a lower risk of complications than traditional chest surgery. Your surgeon can help you understand what to expect from your surgery and what you need to do to prepare.