I. Introduction
Let’s face it, the thought of undergoing surgery can be daunting. But what if I told you there’s a way to achieve the same results with less pain, less scarring, and a faster recovery? Enter Video Assisted Thoracoscopic Surgery (VATS). This minimally invasive procedure is taking the medical world by storm and for good reason. With VATS, doctors can access the chest cavity through small incisions instead of a large open surgery, resulting in less trauma to the body and a quicker recovery time. It’s no wonder that VATS Surgery in India is becoming the go-to option for lung cancer, pleural effusion, emphysema, pneumothorax, esophageal cancer and sympathectomy for hyperhidrosis. So, if you’re facing thoracic surgery, don’t be afraid to ask your doctor about VATS surgery, which is also known as “Keyhole chest surgery” in India. Trust me, you’ll be glad you did.
II. The Advantages of VATS
A. Less invasive:
– VATS is considered less invasive than traditional open thoracic surgery because it uses small incisions ( two or three ) to access the chest cavity, rather than a large open incision. A camera and few long instruments enter the chest through these tiny cuts on the chest. The images are transmitted to a monitor placed in front of the surgeon. The surgeon completes the entire procedure looking at the monitor while manoeuvring his instruments in the chest cavity. This results in less trauma to the body, and less bleeding during the procedure. Not only is the incision small, but also there is no cutting of muscles and spreading of ribs. In recent times the number of small cuts have also decreased with many surgeries now possible with only one tiny incision (Uniportal VATS surgery)
– According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean blood loss of 27.4 ml, compared to 199.4 ml for patients who underwent open thoracic surgery.
B. Faster recovery time:
– One of the most significant benefits of VATS surgery is the faster recovery time compared to traditional open thoracic surgery. According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean recovery time of 7.4 days, compared to 12.8 days for patients who underwent open thoracic surgery. This can be attributed to the smaller incisions and less tissue damage associated with VATS.
Another study published in the Journal of Surgical Oncology found that patients who underwent VATS for lung cancer had a mean hospital stay of 4.1 days, compared to 7.2 days for patients who underwent open thoracic surgery. This is a significant reduction in recovery time, allowing patients to return to normal activities sooner.
C. Reduced pain:
– According to a study published in the Journal of Cardiothoracic Surgery, patients who underwent VATS reported less pain and discomfort compared to those who underwent open thoracic surgery. Again this could be attributed to the smaller size of the incision, avoidance of muscle cutting and rib spreading. The intercostal nerve bundle which runs beneath each rib is also at a lower risk of damage in VATS surgery as compared to an open surgery. In open thoracotomy a rib spreader is used to separate the ribs and if the surgeon is not careful enough the intercostal nerve is likely to get damaged with the metallic spreader leading to pain as well as paraesthesias.
– The study found that the mean visual analogue scale (VAS) score for pain was 2.9 for VATS patients, compared to 4.2 for open thoracic surgery patients.
D. Minimized scarring:
– Smaller incisions used in VATS surgery result in less visible scarring compared to open thoracic surgery. This can be especially important for patients who are concerned about their appearance after surgery. Not only are the incisions kept smaller but are also strategically placed on the chest so as to keep them in the bra-line for females.
– According to a study published in the Journal of Thoracic Disease, the mean length of incisions for VATS was 3.7 cm, compared to 13.2 cm for open thoracic surgery.
E. Improved outcomes:
– VATS surgery has been shown to have similar or better outcomes compared to open thoracic surgery. This includes similar or better survival rates, similar or better lung function, and similar or better quality of life.
– A study in the Journal of Thoracic Disease found that the 5-year overall survival rate was similar for VATS and open thoracic surgery patients (78.5% vs. 78.9%).
III. VATS Surgery in Action
Testimonials from patients who have undergone VATS surgery in India
IV. VATS Surgery in India for Various Thoracic Conditions
A. VATS Surgery for Lung cancer:
-The surgical treatment of lung cancer is anatomical resection of the part of lung having the cancer as well as removal of draining lymph nodes. This may be in the form of segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy etc combined with mediastinal lymph node dissection. All of these anatomical resections are possible by VATS in the hands of an experienced surgeon.
A special kind of lung cancer known as Neuroendocrine tumours of the lung (Carcinoids) are also amenable to VATS or keyhole chest surgery.
B. VATS Surgery for Pleural Effusion and Empyema:
– VATS is an effective option for the treatment of pleural effusion or empyema, a condition in which fluid or pus builds up respectively, in the space between the lung and the chest wall. In this surgery all the fluid or pus surrounding the lung along with pus flakes or debris is evacuated which decreases the infective load from the chest. It also helps to relieve the pressure that had caused the underlying lung to collapse. Sometimes a decortication process would be required to help the lung expand by removing the thick peel that forms around the lung and entraps it.
– VATS for pleural effusion and empyema offers significant improvement in the breathing and quality of life after the procedure.
C. VATS for Emphysema:
– VATS is an effective option for the treatment of emphysema, a lung condition that causes difficulty breathing. The procedure is called LVRS – Lung Volume Reduction Surgery.
– Carefully selected patients who undergo VATS LVRS for emphysema have a significant improvement in their lung function and quality of life after the procedure.
D. VATS Surgery for Pneumothorax:
– Pneumothorax is a condition in which air leaks into the space between the lung and the chest wall, causing the lung to collapse. Often there are underlying lung blebs or bullae. When these blebs/bullae rupture, inhaled air travels from the airways to the thoracic cavity, creating a pneumothorax. VATS bullectomy or blebectomy is offered to such patients for surgical resection of the involved part of lung containing the ruptured bulla or bleb.
– A study published in the Journal of Cardiothoracic Surgery found that patients who underwent VATS for pneumothorax had a rapid recovery and low complication rates.
E. VATS for Mediastinal tumors:
– Commonly mediastinal tumors in the anterior mediastinum are thymoma or teratoma. In younger adults and children mediastinal tumors also form in the posterior mediastinum like neurogenic tumors or cyts. VATS for mediastinal tumors has a high rate of complete tumor resection and low complication rates.
F. VATS for Esophageal cancer
– VATS Esophageal mobilisation and intrathoracic lymph node dissection can be safely done for esophageal cancers. If required a VATS intrathoracic anastomosis can also pe performed.
G. VATS for Bronchiectasis
-Involves resecting the involved lobe or segment. A non-anatomical resection is sufficient because the goal is to resect the diseased part while preserving as much normal lung parenchyma as possible.
H. VATS for Aspergilloma and other fungal diseases
– VATS Lobectomy, VATS pneumonectomy or VATS wedge resection can be done depending on the size and location of the fungus as well as surrounding lung damage.
I. VATS for Hyperhidrosis
– VATS Sympathectomy is the surgery used to treat Palmar Hyperhidrosis which means excessive sweating of the palms.
J. VATS for Lung Abscess and Necrotising Pneumonia
– VATS interventions are also possible for infective conditions like a lung abscess or necrotizing pneumonia. Lung resection may have to be combined with a drainage & decortication in these setting
V. Conclusion
A. Summary of the benefits of VATS surgery (keyhole chest surgery) in India:
– In brief, VATS is a less invasive, more effective alternative to traditional open thoracic surgery. It results in smaller incisions, less tissue damage, faster recovery time, reduced pain, minimized scarring, and improved outcomes.
B. Future developments:
– VATS technology is constantly evolving and improving, and there are several new developments in the pipeline. For example, newer instruments, cameras with better vision and techniques are being developed that will allow for even smaller incisions and less tissue damage.
C. Limitations of VATS surgery:
– VATS is not suitable for all cases and some types of thoracic surgery may require an open thoracotomy. VATS requires a high level of skill and experience to be performed safely and effectively. Managing major complications like severe bleeding may not be possible by VATS especially in the hands of less experienced surgeons.
