Mr Marco Scarci has specialist expertise in video-assisted thoracic surgery (VATS). This is a much less invasive way of removing lung tissue compared with traditional open-chest surgery.
Only available at specialised thoracic surgery centres, VATS lung resections are performed using two to four small incisions, most less than an inch long. A tiny video camera is inserted through one incision and the images are projected on a video monitor to guide the work. The other small incisions are used for surgical instruments.
VATS is most likely to be appropriate for patients with early-stage cancer. Generally it’s not suitable for people receiving chemotherapy before surgery (neoadjuvant treatment) or for removing bulky areas of disease in the chest. Also, VATS may not be appropriate if the surgery would be particularly complex because of the location or other characteristics of the cancer.
‘I do things for my patients that I would want someone to do for me. If I needed thoracic surgery I would find somebody who could do VATS for me.’
Keyhole lung surgery is now the treatment of choice for the vast majority of chest surgery. The main aim is to reduce the invasiveness of surgery to a minimum so that a larger number of patients is potentially eligible to receive this potentially curative treatment.
Whether you can have keyhole lung surgery or not largely depends on the ability of the surgeon, the size of the cancer, and whether it has attacked surrounding areas. Generally speaking due to the advancement in technique and instruments a much larger proportion of patients can be safely operated by keyhole approach.
By the rule of thumb, MIS (minimally invasive surgery) is carried out for its safety, efficacy, and optimal health outcomes. VATS surgeries are advantageous because they reduce the risk of perioperative and postoperative complications. That though does not mean that there are no complications at all ever. What changes is the way the procedure is done, but the operation inside the chest is the same. Each operation carries approximately 1-2% mortality risk, risk of air escaping from the lung from the part that has been cut out, bleeding which could also be severe and require also emergency conversion to open surgery, pain which might become chronic, scarring, injury to the intrathoracic organs, heart attack, stroke.
Keyhole lung surgery does not involve an open incision in the chest cavity, nor does it separates the ribs apart. The result is a reduced risk of bleeding during and after surgery. A small incision, around a couple of inches, allows faster recovery. So, to answer whether or not keyhole lung surgery is a high-risk one, it is actually safer and actively reduces potential risks to patients’ health.
Pneumothorax commonly presents spontaneously in several patients, especially young and tall males. The first treatment for this potentially life-threatening condition is the introduction of the chest tube to allow the escape of entrapped air.
Keyhole surgery for a collapsed lung is now commonly adopted. The main reason behind this is the reduction in pain and decreased physical limitation for the patient. Further, there is reduced analgesic requirement and shortened hospital stays after VATS-assisted management of collapsed lungs.
We will consider the strengths and limitations of VATS in the diagnostic and therapeutic excision of lung nodules. In this case, the first step is the identification and localization of the nodules with a CT-guided pathway.
VATS is a great tool to biopsy small nodules on unknown origin. Often there is a diagnostic uncertainty when small lumps in the lung are not accessible by CT guided biopsy. In those case a surgeon can easily take them out to achieve a diagnosis.
VATS is of limited value for pulmonary nodules that are too small or too far from the visceral pleura to be palpable or detectable by thoracoscopy. The advantage is often well thought-out for nodules that are 20mm or less in size. VATS combined with a CT scan helps remove the lung nodules effectively.
Lung pathologies vary widely in presentation and associated symptoms. At times, patients visit surgeons for acute and chronic lung diseases. Quite frequently, absolute pathologies are difficult to diagnose through radiological interventions. A common example is Interstitial lung disease (ILD). In such cases, a lung biopsy might become necessary to determine the severity and extent of the disease. A complete assessment helps the surgeon devise a suitable plan for surgery. A lung biopsy can be done in a thoracoscopic.
FNAC (fine needle aspiration cytology) and percutaneous needle biopsy are minimally invasive methods for lung biopsy, but the results may not supply enough data. Thoracoscopy for biopsy is now considered a potent and feasible strategy. It provides better vision, reduces patient disability, and offers a greater selection of biopsy sites and better cosmetic outcomes.
VATS is a safe treatment that, in expert hands, allows to perform the vast majority of lung treatments. Patients should not be afraid to discuss any concern with their health care provider. Surgery has changed dramatically in the last few years, so be reassured.