Video-assisted thoracic surgery (VATS) for lung cancer lobectomy

What is VATS?

In video-assisted thoracic surgery (VATS), the surgeon uses a video camera to see inside the body during the procedure. VATS is also sometimes called video-assisted thoracoscopic surgery.

VATS is a minimally invasive surgery. That means the surgeon makes a smaller cut, called an incision, to perform the procedure. VATS is designed to do less damage to the patient’s body than a traditional open surgery would.

Key benefits of minimally invasive surgery for patients include:

• Less pain after surgery
• Shorter hospital stay
• Faster recovery from surgery

What is lobectomy?

The lungs are made up of sections called lobes. The right lung has three lobes. The left lung has two lobes. Lobectomy is a surgery to remove one or more of the lobes.

For lung cancer patients, lobectomy is a way to remove any lobes affected by the cancer to try to prevent the cancer from spreading to other parts of the lungs or to other organs in the body.

How is VATS different from open surgery for lobectomy?

Open surgery lobectomy

Open surgery is the traditional way a surgeon performs an operation. Open surgery requires an incision that is large enough for the surgeon to be able to look into the body and reach inside with instruments.

In an open lobectomy, the surgeon makes an 8-inch-long cut, called a thoracotomy incision, that begins at the front of the chest, extends around the side of the chest, and ends on the back, near the shoulder blade. To be able to operate on the lung, the surgeon may also need to remove a rib or use a device that spreads the rib cage apart.

VATS lobectomy

In a VATS lobectomy, the surgeon doesn’t need to make a large thoracotomy incision. Instead, the surgeon makes several small incisions. The largest incision is about 2 inches long. A device called a thoracoscope is inserted into one of the incisions. A thoracoscope is a very small video camera attached to a tube. It allows the surgeon to see live video of the lung on a computer screen instead of cutting open the chest to see it.

Small surgical tools are inserted into the other incisions. The surgeon performs the lobectomy while watching the lung and the tools on the computer screen.

Advantages of VATS lobectomy

Because the incisions are small, and because the surgeon doesn’t need to separate the rib cage, VATS does less damage to the patient’s body during the surgery. On average, recovery from a VATS lobectomy is two days shorter than recovery from open lobectomy. The patient can typically heal faster after the surgery, with less pain, and get back to a normal life sooner.

One potential complication of open lobectomy is called post-thoracotomy pain syndrome. It results in prolonged, chronic pain after surgery. VATS nearly eliminates the chance of post-thoracotomy pain syndrome.

Patients who undergo VATS typically require smaller doses of pain medicine for shorter periods of time after surgery.

Why choose University of Iowa Health Care for VATS lobectomy?

All University of Iowa Health Care thoracic surgeons are experts in minimally invasive surgery, including VATS lobectomy. More than 70 percent of the lobectomies we perform are done using VATS—well above the national average of under 50 percent¹.

And we can perform the procedure on patients of all age ranges and body types, including patients who have had prior chest surgery.

^{1: Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis. Ann Thorac Surg. 2012 Apr;93(4):1027-32. doi: 10.1016/j.athoracsur.2011.06.007. Epub 2011 Nov 30.}

^{Ninety-Day Costs of Video-Assisted Thoracic Surgery Versus Open Lobectomy for Lung Cancer. Presented at the Poster Session of the Fiftieth Annual Meeting of The Society of Thoracic Surgeons, Orlando, FL, Jan 25–29, 2014. http://dx.doi.org/10.1016/j.athoracsur.2014.03.024}