Medical Content Created by the Faculty of the
Harvard Medical School
VATS is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
VATS is usually done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. Your anesthesiologist can use this tube to make you breathe using only one of your lungs. This way the other lung can be completely deflated and allow the surgeon a full view of your chest cavity on that side during the procedure.
If VATS is being used only to evaluate a problem on the inside of the rib cage (not the lung itself), then it can sometimes be done using regional anesthesia. With regional anesthesia, you are not asleep during the surgery, but are given medicines that make you very groggy and that keep you from feeling pain in the chest. This is done with either a spinal block or an epidural block, in which an anesthesiologist injects the anesthetic through a needle or tube in your back or neck. You do your own breathing with this type of anesthesia, but one of your lungs will be partly collapsed to allow the doctors to move instruments between the lung and the chest wall.
You spend the surgery lying on your side. A very small incision (less than an inch long) is made, usually between your seventh and eighth ribs. Carbon dioxide gas is allowed to flow into your chest through this opening, while your lung on that side is made to partly or completely collapse. A tiny camera on a tube, called a thoracoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen.
If you are having a procedure more complicated than inspection of the chest and lung, the doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These additional incisions are usually made in a curving line along your lower rib cage. A wide variety of instruments are useful in VATS. These include instruments that can cut away a section of your lung and seal the hole left in your lung using small staples, instruments that can burn away scar tissue, and tools to remove small biopsy samples such as lymph nodes from your chest.
At the end of your surgery, the instruments are removed, the lung is re-inflated, and all but one of the small incisions are stitched closed. For most patients, a tube (called a chest tube) is placed through the remaining opening to help drain any leaking air or fluid that collects after the surgery.
If you are having general anesthesia, it is stopped so that you can wake up within a few minutes of your VATS being finished, although you will remain drowsy for a while afterward.