Keyhole (VATS) Lung Cancer Surgery

Expert Keyhole (VATS) Lung Cancer Surgery

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 specialized thoracic surgery centers, 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. 

Benefits of VATS:

  • Less pain – patients need less pain medication after their operation.
  • Less scarring – only two to four small incisions, compared with a six to ten-inch incision for open-chest surgery.
  • Shorter hospital stay – our average time to discharge after VATS is just over two days, compared with up to one week for open-chest surgery.
  • Quicker recovery – many people are back to their usual activities in about a week, whereas four to six weeks’ recovery is needed after open-chest surgery.
Keyhole (VATS) Lung Cancer Surgery
VATS patients

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 (VATS) lung cancer surgery

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. 

Removing Non-malignant Lung Pathologies with Keyhole Surgery

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.

Keyhole Surgery & Lung Biopsy

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.

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FAQs About Chest Wall Deformity

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.

The duration of keyhole lung surgery, also known as video-assisted thoracoscopic surgery (VATS), can vary depending on the individual case and the specific procedure being performed. However, on average, the removal of a lobe of the lung for cancer typically takes about 2 to 3 hours, sometime significantly less. Mostly depends on the size of the cancer and the ability of the surgeon. Our surgeons are pioneers in keyhole surgery and will ensure the best results in your situation.

The recovery time for keyhole lung surgery, also known as video-assisted thoracic surgery (VATS), can vary depending on individual factors and the specific procedure performed. Generally, the recovery period can range from a few weeks to a couple of months.

During the early days following the surgery, you may experience pain, discomfort, and some difficulty breathing. However, as time progresses, these issues should gradually improve. It is common for patients to be able to resume daily activities within a few weeks and return to work within 4-6 weeks, but this can vary.

In Mr Scarci’s practice, 2/3 of patients are discharged within 2 days and are able to resume activities in 2 weeks.

It is important to note that individual recovery times may differ, and it is essential to follow your doctor’s instructions, attend any follow-up appointments, and engage in any recommended rehabilitation or physical therapy to aid in a smooth recovery process.

Keyhole surgery, also known as minimally invasive surgery or video-assisted thoracic surgery (VATS), is a surgical technique used to treat lung cancer. It involves making small incisions in the chest wall, typically around 1-2 cm in size, through which special instruments and a tiny video camera are inserted.

During the procedure, the surgeon guides the instruments and camera through the incisions, allowing them to visualize and access the inside of the chest cavity. The camera provides a magnified view of the lung and surrounding structures, helping the surgeon to perform the necessary surgical procedures.

Keyhole surgery for lung cancer offers several advantages compared to traditional open surgery. These advantages include:

  1. Smaller incisions: The smaller incisions result in less postoperative pain, reduced scarring, and quicker recovery times.
  2. Reduced blood loss: The use of specialized instruments and techniques can help minimize blood loss during surgery.
  3. Shorter hospital stay: Patients undergoing keyhole surgery for lung cancer typically have shorter hospital stays compared to open surgery patients.
  4. Faster recovery: Patients can often resume normal activities sooner after keyhole surgery.
  5. Decreased complications: Keyhole surgery has been associated with a lower risk of complications, such as infections and respiratory complications.

It’s important to note that not all lung cancer cases can be treated with keyhole surgery. The suitability of this technique depends on various factors, including the location and stage of the tumor, as well as the patient’s overall health. A thorough evaluation by a qualified thoracic surgeon is necessary to determine if keyhole surgery is a viable option for a particular patient.

Keyhole lung surgery, also known as minimally invasive thoracic surgery or video-assisted thoracoscopic surgery (VATS), is typically less painful and requires a shorter recovery period compared to traditional open surgery. The procedure involves making small incisions and using small instruments and a camera to perform the surgery. The smaller incisions and reduced tissue trauma often result in less postoperative pain and discomfort.

Mr Scarci only uses one 3cm incision for all his operations; this significantly reduces pain. Moreover, he routinely uses cryoablation of intercostal nerves. This techniques provides pain relief for several months and patients are able to resume their activites much earlier.

However, individual experiences may vary, and pain tolerance differs from person to person. It is best to consult with your healthcare provider to discuss the specifics of your case and any potential pain management options.

The length of time someone stays in the hospital after keyhole lung surgery, also known as video-assisted thoracoscopic surgery (VATS), can vary depending on individual circumstances. Generally, patients can expect to stay in the hospital for around 1 to 3 days after the surgery, assuming no complications arise. However, it’s important to note that each case is unique, and this estimate may vary based on the patient’s condition and the specific details of their surgery. It’s best to consult with a healthcare professional for personalized information regarding your specific situation.

The third day after surgery is often considered the worst because it is typically when post-operative pain and discomfort are at their peak. Here are a few reasons that may contribute to this:

  1. Inflammation: Inflammation and swelling tend to be at their highest around the third day after surgery. The body’s natural healing response can cause discomfort and increased pain during this time.
  2. Medication tapering: Many patients are initially prescribed stronger pain medication after surgery, which gradually tapers off over time. By the third day, the dosage may be lower, causing increased pain that needs to be managed differently.
  3. Muscle stiffness: After surgery, patients often experience muscle stiffness and limited mobility due to the body’s defensive response. This stiffness can lead to increased discomfort and pain on the third day.
  4. Wound healing: The healing process can cause itchiness or a stinging sensation around the incision sites, which can be uncomfortable. By the third day, the initial trauma from the surgery is settling, and the body actively starts healing, which can elicit various sensations.

Remember, everyone’s experience with post-operative recovery can differ, and this answer is a generalization. It’s essential to follow your doctor’s instructions and inform them about any concerning symptoms you may experience during your recovery.

Yes, a lung lobe can be removed through a keyhole surgery technique called video-assisted thoracoscopic surgery (VATS). VATS is a minimally invasive procedure that involves making a few small incisions in the chest and inserting a thin tube with a camera and surgical instruments. This allows the surgeon to visualize and remove the affected lung lobe without requiring a large incision or opening the chest cavity fully. It is commonly used for procedures such as lobectomy, where one or more lung lobes are removed. However, the suitability of VATS for a specific case depends on various factors, including the patient’s medical condition and the exact nature of the lung problem. It’s best to consult with a healthcare professional to determine the most appropriate surgical approach.

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