Minimally Invasive Thoracic Surgery
At present, most thoracic surgery procedures can be performed through two, three, or four small incisions (one cm). A thoracoscope (camera) is introduced together with small instruments in the chest cavity and the procedure done in the same way as an open one. The thoracoscope is connected to a TV monitor and the procedure can be followed on a TV screen and recorded eventually. This is called Video-Assisted Thoracic Surgery (VATS).
Many painful procedures performed through large thoracic incision called thoracotomy (rib spreading) or sternotomy (sternum split) can be done using specific instruments in a minimally invasive way. Surgeons started using minimally invasive techniques in 1990, but these techniques really took off after 1993. At present, only a minority of surgeons offer the full range of interventions using these techniques. Professor Lang-Lazdunski has been performing VATS procedures routinely since 1994 and has published extensively in the field. He has pioneered new thoracic procedures through minimally-invasive approaches, especially for patients with mediastinal tumours, small lung tumours and women presenting with thoracic endometriosis.
Minimally invasive thoracic surgery procedures are often referred to as VATS for video-assisted thoracic surgery, videothoracoscopy or just thoracoscopy.
The main differences between minimally invasive thoracic surgery procedures and classical open approaches are the postoperative pain, which is noticeably reduced with VATS, the rapidity of recovery (much quicker following VATS) and obviously the cosmetics.
There are specific contra-indications to this type of minimally invasive approach and if you have a large tumour (more than 5 cm) or the tumour is attached to the heart, great vessels or esophagus it is likely that the surgeon will have to open your chest to best remove the tumour. In addition, if you have adhesions between the lung and the chest wall, your surgeon may have to make a short incision (4-5 cm) to help introduce the camera and instruments safely into the chest cavity.
Procedures we currently perform using VATS approach:
- Drainage of pleural empyema (Infected collection in the chest cavity)
- Excision of congenital mediastinal cyst
- Excision of lung metastasis (metastasectomy)
- Excision of mediastinal tumour
- Excision of superficial esophageal tumour (benign)
- Insertion of indwelling pleural catheter
- Lung biopsy
- Lung volume reduction for severe emphysema
- Lymph node biopsy
- Pericardial biopsy and creation of a pericardial window (pericardial effusion)
- Pleural biopsy
- Pleurodesis for chylothorax and clipping of thoracic duct
- Pleurodesis for malignant pleural effusion (talc)
- Pleurodesis for pneumothorax (pleurectomy or pleural abrasion)
- Splanchnicectomy for chronic pain (pancreatic cancer or chronic pancreatitis)
- Thoracic sympathectomy for hyperhidrosis
- VATS lobectomy for cancer
- VATS pleurectomy and decortication for mesothelioma
- VATS segmentectomy for cancer
- VATS treatment of thoracic endometriosis
- VATS plication of the diaphragm
However, other procedures can be performed by VATS. Do not hesitate to discuss the possibility of having a VATS approach with your surgeon.
We will generally offer the less invasive approach when technically feasible and when the approach is safe.