What is VATS?
Video-Assisted Thoracoscopic Surgery is also known as VATS, and it is a type of a keyhole surgery where the surgeon makes a few small cuts (about 1cm each) in your chest. Through one of these cuts, a small camera will be inserted, showing live images on a computer screen which will help your surgeon to see inside your chest. Through the other cuts, the surgeon can insert tools to:
- Look at the lungs and chest lining, called the pleura.
- Take tissue samples (biopsies).
- Remove build-up of fluid.
- Treat a collapsed lung.
The VATS procedure is performed under general anaesthesia, which means that you will be asleep. One of the lungs may be temporarily deflated so that the surgeon can examine and operate on it. A special breathing tube placed in your mouth by the anaesthetist will help your other lung to continue to breathe for you.
What is thoracotomy?
A thoracotomy is a type of procedure allowing the surgeon to gain direct access to your lung and perform a lung surgery. Your surgeon will make a cut on the affected side of your chest and access your lung by spreading the ribs. Both thoracotomy and VATS are 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 procedure.
VATS or thoracotomy?
During your consultation, you will be advised on the most appropriate choice for you. You may be asked to consent to both VATS and thoracotomy so that the surgeons have the option, should this becomes necessary.
Why do I need a VATS?
During your initial consultation, your thoracic surgeon will discuss with you why a keyhole (VATS) procedure is the most appropriate option for you. For example, he may recommend VATS in order to:
- Check the chest lining (pleura) and take biopsies.
- Drain fluid build-up in the chest (pleural effusion).
- Treat a collapsed lung (pneumothorax).
- Remove lung tissue containing little air-filled pockets (also called bullae).
- Perform a procedure known as talc pleurodesis (the thoracic pre-assessment nursing team will provide you with additional advice if this procedure is also considered).
Why do I need a thoracotomy?
- Thoracotomy allows your surgeon to do a:
- Lobectomy - the removal of part of the lung containing a lung lesion.
- Segmentectomy / Wedge Resection - the removal of a much smaller part of the lung than a whole lobe.
- Pneumonectomy - removal of the whole lung.
- Lymph node resection – removal of lymph nodes associated with the affected part of the lung.
- Lung decortication – removal of the surface layer of the lung, for example if it is damaged by infection.
Will I have drains after the surgery?
You will likely have one or two chest drains positioned on the same side as your surgery. These drains can remove extra air, fluid or blood from the chest, and they will stay in place for 24–48 hours.
Depending on how much fluid or air is coming out, the drains may need to stay in for a day or several days. The nurses and doctors on the ward will monitor the drains regularly and will let you know when the right time comes for the drains to be removed. After your surgery, you will also have one or more chest X-rays to check your lungs and help the doctors determine when the drains are ready to be removed.
What happens after surgery?
The length of your hospital stay after VATS / thoracotomy is usually 3-5 days if there are no delays in your post-operative recovery. Some of the complications that may occur post-operatively are:
- Air leaking from the lung
- Continuous fluid draining from inside the chest
- Bleeding
- Chest infection
- Infection at the wound site
What are the risks?
All treatments have some risks. Before signing your consent form, your surgeon will discuss with you the risks and benefits of the procedure, and you will have the opportunity to ask questions. The risks of having general anaesthesia will be explained to you by the anaesthetist on the morning of your surgery. If you have any concerns or queries about your procedure and the post-operative recovery, the specialist team of nurses and doctors remain available to you, and you will be given the relevant contact details during the pre-assessment process.
Further information
For more information and advice about your thoracic procedure, your hospital stay, the thoracic team and our enhanced recovery programme, please see our Thoracic Surgery Patient Information Page and Patient Diary. You can get in touch by calling us on 0203 456 6047 or by emailing us at uclh.
Services
Page last updated: 18 September 2025
Review due: 01 September 2027