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What is VATS?

VATS or Video Assisted Thoracoscopic Surgery is a keyhole procedure where several 1-centimetre incisions are made in the chest, and a special instrument with a small video camera at the end is inserted by the surgeon in one of the incisions. The camera feeds video images to a computer screen allowing the surgical team to see inside your chest.

The surgeon will also insert other special surgical instruments into the other incisions, which can then be used to examine the lungs and the chest lining (the pleura), obtain pleural biopsies and remove fluid from the chest. A collapsed lung can also be repaired and reinflated using this technique.

This type of keyhole procedure is usually performed under general anaesthesia, and your lung may or may not be deflated. If the lung is to be examined or operated on by the surgeon, then it will likely be deflated during the VATS procedure. A special breathing tube placed in your mouth by the anaesthetist will help your other lung to continue to work and breathe for you.

You will have the opportunity to discuss your procedure and the general anaesthesia in more detail and ahead of time with both your surgeon and your anaesthetist.

Why do I need a VATS?

During your initial consultation with the surgeon, he will discuss with you why a keyhole (VATS) procedure is the most appropriate surgical approach for you. This surgical method can be used to:

  • Examine the lining of the chest wall (pleura) and obtain biopsies
  • Drain a pleural effusion, which is a build-up of fluid in the lining of the right or left lung
  • Treat a pneumothorax when the lung has collapsed
  • Treat bullous disease by removing lung tissue containing little air-filled pockets called bullae
  • Perform a talc pleurodesis

What is talc pleurodesis?

Talc pleurodesis involves introducing a mildly irritant medical grade talcum powder into the space between your lung and your chest wall. This is done to try to adhere or “stick” your lung to the chest wall to prevent any further collection of fluid or air in this space, called “pleural space”.

The talc, which will be distributed into your pleural space by the surgeon, will cause irritation to the outer lining of your lung and your chest wall. This will result in these surfaces becoming “sticky”, sealing up the space between them and thus preventing fluid or air from collecting there in the future.

Non-steroidal anti-inflammatory (NSAIDs) medication, such as Ibuprofen, should be avoided post-operatively, as they inhibit the process of pleurodesis and may decrease the likelihood of the lung adhering to the chest wall. Your nurses and doctors will advise you on the optimum pain relief.

Will I have drains after the surgery?

After your VATS you will likely have one or two chest drains inserted on the same side as your surgical incision. Their aim is to remove any extra air, fluid or blood that might collect in the chest. The drain(s) will normally remain in place for 24-48 hours after your procedure, or occasionally longer, depending on the amount of drainage of blood, fluid or air present. The nurses and doctors will frequently monitor your drains and inform you of the plan regarding their removal. You may also have a chest Xray.

What happens after surgery?

The length of your hospital stay after VATS is usually 2-3 days or longer if there are any delays in your post-operative recovery. Some of the main complications that may occur post VATS include the following:

  • air leak from the reinflated lung
  • persistent drainage of fluid
  • bleeding
  • chest infection
  • wound infection

What are the risks?

All treatments carry a certain degree of risk. When you are signing your consent form, the surgeon will discuss with you the risks and benefits of the surgery, and you will have the opportunity to ask questions. Any risks associated with general anaesthesia will be explained to you by the anaesthetist on the morning of your procedure.

For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please get in touch by calling us on 0203 456 6047 or by emailing us at