Also known as thoracoscopic surgery or VATS, (video-assisted surgery), is surgery performed with the surgeon looking at the organs inside the chest on a television monitor rather than with direct vision. This is accomplished by passing a television camera on a wand-like device into the chest through a small incision between the ribs. If tissue is to be dissected or removed, additional small incisions, or a larger incision called a mini- thoracotomy are made.
If the surgery is being done without a prior diagnosis of lung cancer, then a peripheral mass in the lung can often be safely and easily removed by stapling off a portion of lung containing the mass. This is called a wedge resection. If the mass is a benign tumor or the scar from a previous infection, then the operation is over.
If the tumor is malignant, the lobe containing the mass should then be removed. Wedge resection alone is much inferior to lobectomy in the treatment of lung cancer, because there is a proven, higher incidence of recurrent tumor and a lower rate of long term survival.
In a patient with severe lung disease, thoracoscopic wedge resection may allow safe removal of the tumor, as a compromise operation, in a patient who would otherwise not be a candidate for thoracotomy.
Dissection of blood vessels and bronchi, as well as ligating or stapling of these structures then allows removal of lung tissue. Removal of lung cancer in this fashion is now technically possible, in highly selected patients. There is very little experience with such surgery, and it's safety and effectiveness have not yet been firmly established. Complete lymph node dissection cannot be accomplished with this approach. Removal of large tumors near the hilum is not safe with this method. Thoracoscopic lobectomy is an experimental approach and should only be done by surgeons with extensive experience with thoracoscopic surgery, within the structure of a research protocol.
Minimally invasive surgery usually has a low complication and mortality rate and a shorter duration of in hospital care, with a more rapid return to normal activities. For more information on thoracoscopic surgery