Mesothelioma Treatments: Surgical Techniques – Video-Assisted Thoracoscopic Surgery (VATS)
Mesothelioma typically affects the lining of the lungs, is highly aggressive and is resistant to many standard cancer treatments, limiting the treatment options. Most patients do not receive a diagnosis until after symptoms appear, which can be 30 years or more after asbestos exposure, the primary cause of the cancer. The prognosis for mesothelioma patients is usually grim with no known cures, and with the average survival time varying from 4 – 18 months after diagnosis.
Video-assisted thoracic surgery (VATS) is a minimally-invasive surgical technique used on cancer patients 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 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 is 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, the lungs 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.
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 cannot 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.
For more information related to surgical treatment, please read the following:
- Mesothelioma Treatment: Surgery
- Mesothelioma Treatment: Curative Surgery – Extrapleural Pneumonectomy
- Mesothelioma Treatment: Curative Surgery – Pleurectomy-Decortication
- Mesothelioma Treatment: Palliative Surgery – Debulking Pleurectomy
- Mesothelioma Treatment: Palliative Surgery – Decortication of the Lung
- Mesothelioma Treatment: Palliative Surgery – Pleural Catheters and Pleuroperitoneal Shunts
- Mesothelioma Treatment: Palliative Surgery – Pleurodesis
- Mesothelioma Treatment: Surgical Techniques – Thoracotomy