Mesothelioma Treatments: Surgical Techniques -
Video-Assisted Thoracoscopic Surgery (VATS)
Video-assisted thoracic surgery (VATS) is a
minimally-invasive surgical technique that uses a small video camera, known as a
thorascope, to guide the surgeon through the interior spaces of the
thorax. When compared to
thoracotomy, it features a higher success rate for many
procedures and a shorter recovery time for nearly all of them. As such, VATS has
largely replaced the use of thoracotomy for many
diagnostic and
palliative procedures.
Video-Assisted Thoracoscopic Surgery (VATS)- Overview of the Procedure
Video-assisted thoracic surgery (VATS) is a relatively recent advancement
in the practice of thoracic surgery and has excellent application to the
diagnosis and treatment of
mesothelioma. It is a less-invasive technique than is
thoracotomy and it associated with better patient response than is the
traditional procedure.
In a VATS procedure, at least two small incisions are
made in the patient’s side. The thorascope is inserted
through one of the incisions, and the diagnostic/surgical
instruments are inserted through the other(s). The
thorascope is attached to a monitor that allows the surgeon
to see a detailed view of the pleural cavity and its
surrounding tissues. Using the tools inserted through the
other incision(s), the surgeon can then complete the chosen
diagnostic test or surgical treatment without ever having to
physically see inside the patient’s body. This is the
feature that gives VATS a greater efficacy than thoracotomy:
thoracotomy uses a large incision because doctors have
traditionally required an entry point that allows good
exposure of the interior spaces, while VATS can be deployed
through small incisions that do not require the removal or
transection of large muscles and tissue structures.
VATS can successfully be applied to many of the
procedures that are associated with mesothelioma treatment
and diagnosis. It allows the exploration of the visible
tissue structures in the chest, as well as the removal of
tissue or fluid samples for biopsy. VATS aids in the
staging of patient disease through an analysis of tissue
appearance and may also be used for lymph node resection if
lymph node involvement is suspected. Surgically speaking,
VATS represents a major improvement in the palliative use of
pleurectomies and
decortications.
VATS is also used to treat a variety of
other cancers, including
lung cancer.
Video-Assisted Thoracic Surgery (VATS) – Treatment
Considerations and Conclusions
The introduction of VATS has revolutionized many aspects of contemporary
thoracic surgery. It is a minimally-invasive procedure with a wide domain of
application, so patients tend to respond better to VATS procedures than they
do traditional thoracic surgeries. However, this does not mean that VATS can
be deployed during every thoracic surgery for every patient. VATS is most
effective on patients who have not had previous chest surgeries, as the scar
tissue associated with these invasive procedures will complicate, and
possibly even prevent, VATS deployment. These patients, then, may still
require thoracotomy for entry into the chest.
Radical surgery is the other area in which VATS can not
be performed. These surgeries require the removal of a large
amount of tissue and are best performed with the extensive
exposure that thoracotomy provides of the pleural cavity and
its associated structures.
Pleurectomy/decortication and
extrapleural pneumonectomy are extensive
procedures and require more operative freedom than VATS
presently allows. In nearly all other cases though, VATS
represents a tremendously important advancement in the
practice of thoracic surgery in general and in the
treatment of mesothelioma in particular.
Related Information: Mesothelioma &
Surgery
For more information related to the surgical treatment of mesothelioma, please read the following:
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