Minimally Invasive Thoracic Oncology for Lung and Chest Cancers
Introduction
Video-Assisted Thoracic Surgery (VATS) is a minimally invasive surgical technique used to
diagnose and treat conditions within the chest, including lung cancer, mediastinal tumours,
pleural diseases, and early-stage esophageal cancers. By using small incisions, a
high-definition camera, and specialised thoracoscopic instruments, VATS enables surgeons to
perform complex procedures with significantly less pain, reduced complications, and faster
recovery compared to traditional open thoracotomy.
VATS has become the gold standard for many thoracic oncology procedures, backed by strong
evidence demonstrating oncologic safety, improved short-term outcomes, and excellent
functional recovery. At our clinic, these procedures are performed by specialised thoracic and
surgical oncologists who follow international guidelines and enhanced recovery pathways—all in
alignment with our values of Cure, Precision, and Compassion.
1. What Is Video-Assisted Thoracic
Surgery (VATS)?
VATS is a minimally invasive approach that uses:
● Small incisions (usually 2–3 cm)
● A thoracoscope (a tiny camera)
● Long, thin instruments
The thoracoscope transmits high-definition images to a monitor, allowing surgeons to operate
with precision inside the chest cavity.
How It Differs From Open Thoracotomy
Traditional thoracotomy requires spreading or cutting the ribs through a large incision. VATS
avoids this, leading to:
● Less trauma
● Less postoperative pain
● Lower complication rates
● Shorter hospital stay
2. Conditions Commonly Treated With
VATS
VATS is used in both diagnostic and therapeutic thoracic oncology
A. Lung Cancer
1. VATS Lobectomy
The standard curative procedure for early-stage non-small-cell lung cancer (NSCLC).
Benefits:
● Adequate lymph node dissection
● Comparable oncologic outcomes to open lobectomy
● Faster return to normal function
2. VATS Segmentectomy or Wedge Resection
Used for:
● Very early-stage tumours
● Patients with reduced lung reserve
● Metastatic lesions requiring limited resections
B. Mediastinal Tumours
● Thymomas
● Neurogenic tumours
● Cysts
● Lymph node biopsy and removal
C. Pleural Diseases
● Pleural effusions
● Pneumothorax
● Pleural biopsies
● Mesothelioma (selected procedures)
D. Esophageal Procedures
● Esophageal mobilisation
● Biopsies or staging procedures
E. Diagnostic Thoracoscopy
Used to obtain tissue for biopsy in:
● Lung cancer
● Pleural malignancies
● Unexplained chest diseases
3. Advantages of VATS
1. Less Pain and Faster Recovery
Small incisions avoid muscle and rib damage, resulting in:
● Lower pain scores
● Less need for opioids
● Early mobilisation
2. Shorter Hospital Stay
Most patients go home in 3–5 days compared to 7–10 days with open surgery
3. Better Lung Function Preservation
Avoiding rib spreading leads to faster return of pulmonary function
4. Lower Risk of Complications
Reduced rates of:
● Infection
● Respiratory complications
● Bleedingv
● Arrhythmias
5. Better Cosmetic Results
Minimal scarring compared to larger thoracotomy incisions
6. Proven Oncologic Safety
Multiple studies confirm:
● Equivalent lymph node retrieval
● Comparable long-term survival
● Adequate tumour margins
When performed by experienced surgeons, VATS is as effective as open surgery
4. Limitations of VATS
VATS may not be suitable in the following situations:
Tumour Factors
● Very large tumours
● Tumours invading chest wall or major vessels
● Central tumours close to the main bronchus
● Dense adhesions due to prior surgeries or infection
Patient Factors
● Severe cardiopulmonary compromise
● Inability to tolerate single-lung ventilation
Our surgeons evaluate each patient to determine the safest and most effective approach.
5. How VATS Is Performed
VATS follows a systematic, evidence-based process:
1. Anaesthesia
Patients are placed under general anaesthesia with single-lung ventilation to provide a clear
field.
2. Positioning
Patients are positioned on their side (lateral decubitus position).
3. Port Placement
Typically 2–4 ports are used:
● One camera port
● Two or three working ports
4. High-Definition Visualisation
A thoracoscope provides a wide, magnified view of chest structures.
5. Tumour Resection
The surgeon performs the planned procedure, such as:
● Lobectomy
● Segmentectomy
● Wedge resection
● Mediastinal tumour removal
6. Lymph Node Dissection
Systematic dissection is performed to ensure accurate cancer staging.
7. Chest Tube Placement
A chest drain is inserted to allow the lungs to re-expand after surgery.
8. Closure
Small, neat sutures are used to close the incisions.
6. VATS Lobectomy: The Gold Standard
for Early Lung Cancer
VATS lobectomy is now recommended by many global thoracic societies for early-stage
NSCLC.
Oncologic Benefits
● Complete cancer removal
● Adequate hilar and mediastinal lymph node sampling
● Lower operative morbidity
Functional Benefits
● Reduced post-operative pain
● Earlier pulmonary rehabilitation
● Better long-term lung function
Survival Outcomes
Multiple trials show equivalent or superior survival compared to open surgery when
performed appropriately.
7. Enhanced Recovery After VATS
Enhanced recovery protocols (ERAS) further improve short-term outcomes.
Preoperative Measures
● Smoking cessation
● Breathing exercises
● Optimised nutrition
● Clear instructions and counselling
Intraoperative Measures
● Minimally invasive technique
● Precision dissection
● Minimal blood loss
Postoperative Measures
● Early mobilisation (day of surgery or next day)
● Early chest tube removal when safe
● Adequate pain control using regional blocks
● Respiratory physiotherapy
8. Recovery After VATS
Hospital Stay
Most patients are discharged within 3–5 days.
Pain
Generally mild to moderate; controlled with oral medications.
Daily Activities
● Light activities in 2 weeks
● Return to work in 3–4 weeks (depending on occupation)
● Strenuous activity in 6 weeks
Follow-up
Includes wound checks, imaging, pathology review, and planning of adjuvant therapy if needed.
9. Potential Risks and Complications
While VATS is safe, potential risks include:
● Air leak
● Infection
● Bleeding
● Arrhythmias
● Conversion to open surgery (rare)
● Respiratory complications
● Shoulder or nerve pain
These risks are minimised through strict protocols, advanced equipment, and experienced
surgical teams.
10. Why Choose Our Clinic for VATS
1. Experienced Thoracic Surgical Team
Performing high-volume VATS resections with excellent outcomes
2. Advanced Technology
● High-definition 4K thoracoscopes
● Energy devices
● Improved optical systems
3. Multidisciplinary Planning
Each case is evaluated by:
● Surgical oncologists
● Pulmonologists
● Medical oncologists
● Radiologists
● Anaesthesiologists
4. Evidence-Based Care
We follow NCCN, ESMO, ACCP, and IASLC guidelines.
5. Enhanced Recovery Protocols
Structured pathways ensure rapid return to normal life.
6. Compassionate Patient Support
Clear communication and holistic care at every stage—from diagnosis to recovery.
Conclusion
Video-Assisted Thoracic Surgery has become an essential part of modern thoracic oncology. By
combining minimally invasive techniques with exemplary surgical precision, VATS offers patients
improved comfort, faster recovery, reduced pain, and excellent cancer control. When performed
by expert surgeons within a multidisciplinary system, VATS achieves outcomes that are equal
to, or better than, open surgery for many thoracic cancers.
At our clinic, we provide VATS with a steadfast commitment to Cure, Precision, and
Compassion, ensuring every patient receives the safest, most advanced, and most
personalised care.
