Thoracoscopic Cancer Surgery (VATS)
Message from Dr. Ajay Simha
A diagnosis of cancer involving the lungs or chest can be overwhelming for patients and their families. When surgery is recommended, patients naturally have concerns about the type of procedure, surgical safety, pain, recovery and how the operation may affect their breathing and daily activities.
Advances in thoracic surgery have made it possible to perform selected cancer operations through small incisions using video-assisted thoracoscopic surgery (VATS). VATS is a minimally invasive approach that allows the surgeon to view and operate inside the chest using a camera and specialized instruments.
I am Dr. Ajay Simha, Consultant Surgical Oncologist (Cancer Surgeon), and this page provides an overview of thoracoscopic cancer surgery, including when VATS may be recommended, how patients are evaluated, available surgical approaches, recovery and commonly asked questions.
What Is Thoracoscopic Cancer Surgery (VATS)?
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used to diagnose, stage and treat selected conditions involving the chest, including certain lung cancers. During VATS, a thin camera called a thoracoscope is introduced into the chest through a small incision.
When is Thoracoscopic Cancer Surgery (VATS) Recommended?
VATS may be considered when cancer within the chest can be safely and effectively diagnosed, staged or treated using a minimally invasive approach.
The suitability of VATS depends on several factors, including:
- Type and location of the cancer
- Size and extent of the tumour
- Stage of the cancer
- Involvement of nearby lymph nodes or structures
- Overall lung function
- Patient’s general health and fitness for surgery
- Previous chest surgery or treatment
- Whether complete cancer removal can be achieved safely through VATS
VATS is commonly considered for selected early-stage lung cancers. However, the technique is not appropriate for every tumour or every patient. In more extensive or technically complex cases, open thoracic surgery or another surgical approach may be recommended.
Evaluation of Thoracoscopic Cancer Surgery (VATS)
A detailed evaluation is performed before VATS to understand the cancer, determine its stage and assess whether the patient can safely undergo surgery.
Imaging investigations such as CT scans or PET-CT may be performed to determine the location and extent of the tumour and assess nearby lymph nodes or other areas of concern.
A biopsy may be required to establish the diagnosis and identify the type of cancer. In selected situations, thoracoscopy itself may be used to obtain tissue samples from the lung, pleura, chest wall or lymph nodes.
Treatment Options for Thoracoscopic Cancer Surgery (VATS)
Cancer treatment depends on the type, stage and location of the cancer, as well as the patient’s overall health. Surgery may form one part of a multidisciplinary treatment plan and may be combined with other cancer treatments when appropriate.
Surgery may be recommended for selected cancers that can be removed safely. In lung cancer, the extent of surgery may range from removal of a small portion of the lung to removal of an entire lobe or, in selected circumstances, a larger portion of the lung.
Chemotherapy uses anti-cancer medicines to destroy or control cancer cells. Depending on the type and stage of cancer, chemotherapy may be given before surgery to reduce tumour burden, after surgery to reduce the risk of recurrence, or as part of treatment for advanced disease.
Radiation therapy uses high-energy radiation to destroy cancer cells. It may be recommended before or after surgery for selected cancers or used as part of treatment when surgery is not appropriate.
The decision depends on the type, stage and location of the cancer and the patient's overall treatment plan.
Immunotherapy helps the body's immune system recognize and attack cancer cells. It may be recommended for selected cancers based on the type and stage of disease and specific characteristics of the tumour.
Targeted therapy uses medicines designed to act on specific molecular changes or biological pathways involved in cancer growth.
These treatments may be considered when the tumour has specific molecular or genetic characteristics that make it suitable for targeted treatment.
Supportive Care
Supportive care is an important part of cancer treatment and recovery. It helps patients maintain nutrition, physical strength, breathing capacity, mobility and overall well-being.
Nutritional Support
Adequate nutrition is important before and after thoracic cancer surgery. Patients may have reduced appetite or increased nutritional requirements during cancer treatment and recovery. A personalized nutritional plan may be recommended based on the patient’s nutritional status, cancer type and planned surgery.
Physiotherapy
Physiotherapy and early mobilization are important components of recovery following thoracic surgery. Breathing exercises, mobility training and physical rehabilitation may help patients improve functional recovery and gradually return to their normal activities. The rehabilitation plan is tailored according to the type of surgery and the patient’s overall condition.
Surgical Approaches for Thoracoscopic Cancer Surgery (VATS)
The choice of thoracic surgical approach depends on the type and location of cancer, its extent, the patient’s health and the specific operation required.
A wedge resection involves removing a small, wedge-shaped portion of the lung containing the tumour along with a surrounding margin of healthy tissue.
It may be considered for selected small or early-stage lung tumours and in certain patients where a larger lung resection may not be appropriate.
Recovery varies depending on the type and extent of surgery, the patient's lung function and general health, and whether additional cancer treatment is required.
Because VATS uses smaller incisions than thoracotomy, appropriately selected patients may experience less postoperative pain and recover more quickly. Hospital stay may also be shorter compared with open thoracic surgery.
Possible complications can include bleeding, infection, pneumonia, blood clots, reactions to anaesthesia and breathing-related problems. The specific risks depend on the type of operation and the patient's overall health.
Dr. Ajay Simha has experience in advanced cancer surgery using minimally invasive, thoracoscopic and open surgical techniques. The choice of surgical approach is individualized, with emphasis on complete cancer removal, patient safety, surgical precision and appropriate recovery.
Frequently Asked Questions
VATS, or video-assisted thoracoscopic surgery, is a minimally invasive technique used to diagnose, stage and treat selected cancers involving the chest. The surgeon operates through small incisions using a camera and specialized instruments.
No. VATS is most commonly considered for selected patients, particularly those with cancers that can be safely treated through a minimally invasive approach. Tumour size, location, stage, lymph node involvement, lung function and overall health all influence the decision.
For appropriately selected patients, VATS may provide smaller incisions, less postoperative pain, a shorter hospital stay and faster recovery compared with conventional thoracotomy.
For appropriately selected patients, VATS can be used to perform definitive cancer operations such as wedge resection, segmentectomy or lobectomy. The objective is to remove the cancer with the appropriate surrounding tissue and evaluate or remove lymph nodes when required.
Depending on the tumour and individual patient factors, VATS may be used for procedures such as wedge resection, segmentectomy, lobectomy and lymph node evaluation or dissection.