What is Video-Assisted Thoracic Surgery

Video-assisted thoracic surgery (VATS) is a procedure that lets your doctor look inside your chest and do small procedures. Your thoracic area is between your neck and belly. VATS may be done to:

• Study or find chest problems.
• Take out a sample of tissue for a test (biopsy).
• Put medicines in your chest.
• Take out fluid, pus, or blood.
• Take out lumps (tumors).
• Take out part of a lung (lobectomy).
• Treat some backbone (spine) problems.

VATS is done by putting a thin tube (thoracoscope) in your chest. The tube has a light and camera on the end. The tube sends pictures to a TV screen. This lets your doctor see inside your chest.

What happens before the procedure of VATS?

Medicines

• Ask your doctor about:
  • Changing or stopping your normal medicines. This is important if you take diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your doctor tells you not to.
• You may be given antibiotic medicine.

Staying hydrated

Follow instructions from your doctor about hydration. Instructions may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids. These include water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your doctor about eating and drinking. Instructions may include:

• 8 hours before the procedure – stop eating heavy meals or foods. This includes meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods. This includes toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have a blood or pee (urine) sample taken.
• You may have tests, such as:
  • Chest X-ray.
  • Electrocardiogram (ECG).
  • Ultrasound.
  • CT scan.
• Do not use any products that have nicotine or tobacco. These include cigarettes and e-cigarettes. If you need help quitting, ask your doctor.
• Plan to have someone take you home.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be placed into one of your veins.
• You may be given:
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine to help you relax (sedative).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• A thin tube (catheter) will be placed into your bladder and in your tube that carries pee (urine) out of your body. The catheter will drain your pee.
• 1–4 small cuts will be made in your chest.
• A tube with a camera on it will be placed into a cut. This helps your surgeon see inside your chest.
• One of your lungs will have air taken out of it (will be deflated). This helps your surgeon see the area.
• Any procedures that you need will be done.
• Air will be put back into your lung (it will be inflated).
• A chest tube may be placed through a cut. This drains fluid.
• Other cuts will be closed with stitches (sutures) or staples.
• A bandage (dressing) may be placed over your cut(s).

The procedure may vary.

What happens after the procedure?

• You will be monitored until your medicines have worn off.
• You may have a chest tube. It will be watched for signs of fluid or air buildup.
• You may get fluids and medicines through an IV tube.
• You may have to wear stockings to help prevent blood clots and reduce swelling (compression stockings).
• Do not drive for 24 hours if you were given a medicine to help you relax.

Summary

• Video-assisted thoracic surgery (VATS) is a procedure that lets your doctor look inside your chest and do small procedures.
• VATS is done to study or find problems in your chest.
• After the procedure, you may have a tube draining fluid from your chest.

Video-Assisted Thoracic Surgery, Care After

This sheet gives you information about how to care for yourself after your procedure. Your doctor may also give you more specific instructions. If you have problems or questions, contact your doctor.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some pain and soreness in your chest.
• Pain when you breathe in (inhale) and cough.
• Trouble pooping (constipation).
• Tiredness (fatigue).
• Trouble sleeping.

Follow these instructions at home:

Preventing lung infection (pneumonia)

• Take deep breaths or do breathing exercises as told by your doctor.
• Cough often. Coughing is important to clear thick spit (phlegm) and open your lungs.
• You can make coughing hurt less if you try supporting (splinting) your chest. Try one of these when you cough:
  • Hold a pillow against your chest.
  • Place both hands flat on top of your cut.
• Use an incentive spirometer as told by your doctor. This is a tool that measures how well you can fill your lungs with each breath.
• Do lung therapy (pulmonary rehabilitation) as told.

Medicines

• Take over-the-counter or prescription medicines only as told by your doctor.
• If you have pain, take pain-relieving medicine before your pain gets very bad. Doing this will help you breathe and cough more comfortably.
• If you were prescribed an antibiotic medicine, take it as told by your doctor. Do not stop taking the antibiotic even if you start to feel better.

Activity

• Ask your doctor what activities are safe for you.
• Avoid activities that use your chest muscles for 3–4 weeks or longer.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your doctor tells you, until he or she says that it is safe.

Cut (incision) care

• Follow instructions from your doctor about how to take care of your cut(s) from surgery. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If you cannot use soap and water, use hand sanitizer.
  • Change your bandage as told by your doctor.
  • Leave stitches (sutures), skin glue, or skin tape (adhesive) strips in place. They may need to stay in place for 2 weeks or longer. If tape strips get loose and curl up, you may trim the loose edges. Do not remove tape strips completely unless your doctor says it is okay.
• Keep your bandage dry until it has been removed.
• Every day, check the area around your cut(s) for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your doctor approves. You may take showers.
• After your bandage is removed, use soap and water to gently wash the your cut(s) from surgery. Do not use anything else to clean your cut(s) unless your doctor tells you to do this.

Driving

• Do not drive until your doctor approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Eating and drinking

• Eat a healthy diet as told by your doctor. A healthy diet includes:
  • Lots of fresh fruits and vegetables.
  • Whole grains.
  • Low-fat (lean) proteins.
• Limit foods that are high in fat and processed sugars. These include fried and sweet foods.
• Drink enough fluid to keep your pee (urine) clear or light yellow.

General instructions

• To prevent or treat trouble pooping while you are taking prescription pain medicine, your doctor may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that have a lot of fiber. These include beans, fresh fruits and vegetables, and whole grains.
• Do not use any products that contain nicotine or tobacco. These include cigarettes and e-cigarettes. If you need help quitting, ask your doctor.
• Avoid being where people are smoking (avoid secondhand smoke).
• Wear compression stockings as told by your doctor. These stockings help you:
  • Not get blood clots in your legs.
  • Have less swelling in your legs.
• If you have a chest tube, care for it as told by your doctor.
• Do not travel by airplane during the 2 weeks after your chest tube is removed, or until your doctor says that this is safe.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have redness, swelling, or pain around a cut from surgery.
• You have fluid or blood coming from a cut from surgery.
• Your cut(s) from surgery feel warm to the touch.
• You have pus or a bad smell coming from a cut from surgery.
• You have a fever or chills.
• You feel sick to your stomach (nauseous).
• You throw up (vomit).
• You have pain that does not get better with medicine.

Get help right away if:

• You have chest pain.
• Your heart is fluttering or beating fast.
• You start to have a rash.
• You have shortness of breath.
• You have trouble breathing.
• You are confused.
• You have trouble talking or understanding.
• You feel weak, light-headed, or dizzy.
• You faint.

Summary

• To help prevent lung infection (pneumonia), take deep breaths or do breathing exercises as told by your doctor.
• Cough often. This is important for clearing chest fluid (phlegm). You can make coughing hurt less if you hold a pillow to your chest or put your hands flat on the cut(s) when you cough (do splinting).
• Do not drive until your doctor approves.
• Every day, check your cut(s) for signs of infection. These signs can be redness, swelling, pain, fluid, blood, warmth, pus, or a bad smell.
• Eat a healthy diet. This includes lots of fresh fruits and vegetables, whole grains, and low-fat (lean) proteins.